Provider Demographics
NPI:1831279991
Name:WANG, DAN-PHUONG HO (MD)
Entity Type:Individual
Prefix:
First Name:DAN-PHUONG
Middle Name:HO
Last Name:WANG
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 1:5939 HARRY HINES BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6262
Mailing Address - Country:US
Mailing Address - Phone:214-645-3900
Mailing Address - Fax:214-645-3901
Practice Address - Street 1:5939 HARRY HINES BLVD STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6262
Practice Address - Country:US
Practice Address - Phone:214-645-3900
Practice Address - Fax:214-645-3901
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000A76031208M00000X
TXR9699208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA76031BMedicare PIN