MEDICARE: PRESTON PRIMARY MEDICAL CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1447128186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON PRIMARY MEDICAL CLINIC PA

Provider Business Mailing Address
First Line	:	7712 SAN JACINTO PL STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3212
Country	:	US
Telephone Number	:	972-669-1212
Fax Number	:	972-669-1313

Provider Business Practice Location Address
First Line	:	7712 SAN JACINTO PL STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3212
Country	:	US
Telephone Number	:	972-669-1212
Fax Number	:	972-669-1313

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	FANG WANG
Credential	:	DO
Telephone Number	:	214-663-4029

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	10/24/2025

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