Provider Demographics
NPI:1871638528
Name:WANG'S WELLCARE PA
Entity Type:Organization
Organization Name:WANG'S WELLCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-527-8997
Mailing Address - Street 1:PO BOX 20271
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0271
Mailing Address - Country:US
Mailing Address - Phone:713-527-8997
Mailing Address - Fax:713-527-8999
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 690
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-527-8997
Practice Address - Fax:713-527-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5607207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022PLOtherBCBS TX
TXH66030Medicare UPIN
TX0022PLOtherBCBS TX