Healthcare Provider Details

I. General information

NPI: 1619037405
Provider Name (Legal Business Name): WAN-LIN HORNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 102
GLENDALE AZ
85308-5665
US

IV. Provider business mailing address

20325 N 51ST AVE STE 102
GLENDALE AZ
85308-5665
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-4271
  • Fax: 602-253-4273
Mailing address:
  • Phone: 602-253-4271
  • Fax: 602-253-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number04-32360
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57515
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: