Provider Demographics
NPI:1700863560
Name:HUANG, WENTIAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WENTIAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 COLLINS BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-3621
Mailing Address - Country:US
Mailing Address - Phone:972-530-5550
Mailing Address - Fax:972-530-3632
Practice Address - Street 1:3475 COLLINS BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044
Practice Address - Country:US
Practice Address - Phone:972-530-5550
Practice Address - Fax:972-530-3632
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W7364OtherBCBS
TX180748901Medicaid
TX8G6136Medicare PIN
TX8W7364OtherBCBS
TXP00336515Medicare PIN