Provider Demographics
NPI:1720075096
Name:WANG, LIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LIN
Middle Name:
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 1:3115 COLLEGE PARK DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4001
Mailing Address - Country:US
Mailing Address - Phone:936-321-6787
Mailing Address - Fax:936-321-6802
Practice Address - Street 1:3115 COLLEGE PARK DR STE 107
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-321-6787
Practice Address - Fax:936-321-6802
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176100902Medicaid
TX176100902Medicaid
TXI20435Medicare UPIN