Provider Demographics
NPI:1194960997
Name:JENNIFER H WANG DPM PC
Entity type:Organization
Organization Name:JENNIFER H WANG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:877-801-1188
Mailing Address - Street 1:13502 PADDINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1930
Mailing Address - Country:US
Mailing Address - Phone:877-801-1188
Mailing Address - Fax:888-592-3646
Practice Address - Street 1:13502 PADDINGTON CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1930
Practice Address - Country:US
Practice Address - Phone:877-801-1188
Practice Address - Fax:888-592-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1646213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218450901Medicaid
TXD06387OtherRAILROAD
TX0085WHOtherBC/BS
TX2184509Medicaid
TX218450901Medicaid