Provider Demographics
NPI:1386677268
Name:WANG, RUN (MD)
Entity Type:Individual
Prefix:
First Name:RUN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1527
Mailing Address - Country:US
Mailing Address - Phone:832-325-7280
Mailing Address - Fax:713-512-7104
Practice Address - Street 1:6414 FANNIN ST
Practice Address - Street 2:G150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1517
Practice Address - Country:US
Practice Address - Phone:713-704-2494
Practice Address - Fax:713-704-6260
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5176208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3641OtherBCBS
TX153132901Medicaid
TX8G3641OtherBCBS
TXH70853Medicare UPIN
TX340020372Medicare PIN