Provider Demographics
NPI:1760748859
Name:WANG, CHONGHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHONGHUA
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1110 COTTONWOOD LN STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6121
Mailing Address - Country:US
Mailing Address - Phone:972-472-7181
Mailing Address - Fax:469-524-3436
Practice Address - Street 1:1110 COTTONWOOD LN STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6121
Practice Address - Country:US
Practice Address - Phone:972-472-7181
Practice Address - Fax:469-524-3436
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1319208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine