Provider Demographics
NPI:1104807759
Name:WANG, NAN (M D)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 SOUTHWEST FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7163
Mailing Address - Country:US
Mailing Address - Phone:713-467-3393
Mailing Address - Fax:832-467-3393
Practice Address - Street 1:4645 SOUTHWEST FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7163
Practice Address - Country:US
Practice Address - Phone:713-467-3393
Practice Address - Fax:832-467-3393
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3035207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141970704Medicaid
TX141970703OtherCSHCN
TX81425KMedicare PIN