Provider Demographics
NPI:1962628842
Name:WANG, XIAO YUN (MD)
Entity type:Individual
Prefix:
First Name:XIAO YUN
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:PO BOX 164106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-4106
Mailing Address - Country:US
Mailing Address - Phone:512-324-7516
Mailing Address - Fax:512-324-7536
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-7516
Practice Address - Fax:512-324-7536
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS32299207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195386101Medicaid
TX8BL181OtherBCBSTX
TX8BL181OtherBCBSTX
TX195386101Medicaid