Provider Demographics
NPI:1619037405
Name:HORNG, WAN-LIN (MD)
Entity Type:Individual
Prefix:
First Name:WAN-LIN
Middle Name:
Last Name:HORNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 N 51ST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5665
Mailing Address - Country:US
Mailing Address - Phone:602-253-4271
Mailing Address - Fax:602-253-4273
Practice Address - Street 1:20325 N 51ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5665
Practice Address - Country:US
Practice Address - Phone:602-253-4271
Practice Address - Fax:602-253-4273
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32360208600000X
AZ57515208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200427370AMedicaid
KS200427370AMedicaid