Provider Demographics
NPI:1629395967
Name:WANG, THOMAS TIEN-YAU (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:TIEN-YAU
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SHIRE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2236
Mailing Address - Country:US
Mailing Address - Phone:972-487-6400
Mailing Address - Fax:972-487-1686
Practice Address - Street 1:3600 SHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2236
Practice Address - Country:US
Practice Address - Phone:972-487-6400
Practice Address - Fax:972-487-1686
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365585401Medicaid