Provider Demographics
NPI:1528797420
Name:WANG, YIFAN (MD)
Entity type:Individual
Prefix:MS
First Name:YIFAN
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 1:74 KENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BEACONSFIELD
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H9W5K4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESSLER STREET, UNIT 1484
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-794-1552
Practice Address - Fax:704-446-9120
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2024-08-23
Deactivation Date:2023-03-03
Deactivation Code:
Reactivation Date:2024-08-23
Provider Licenses
StateLicense IDTaxonomies
TXBP10088510390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program