Provider Demographics
NPI:1619950565
Name:WANG, JENNIFER H (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:WANG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 PADDINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1930
Mailing Address - Country:US
Mailing Address - Phone:877-801-1188
Mailing Address - Fax:888-592-3646
Practice Address - Street 1:13502 PADDINGTON CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1930
Practice Address - Country:US
Practice Address - Phone:877-801-1188
Practice Address - Fax:888-592-3646
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1646213ES0131X, 213E00000X
NYN005645213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160910901Medicaid
TX160910903Medicaid
TXP00695818OtherRAILROAD
TX8CS732OtherBC/BS
TX160910903Medicaid