Healthcare Provider Details

I. General information

NPI: 1285098376
Provider Name (Legal Business Name): ANDREW WANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD STE 401
AUSTIN TX
78723-3078
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD STE 401
AUSTIN TX
78723-3078
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1810
  • Fax:
Mailing address:
  • Phone: 512-628-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10055843
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberS0119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: