Healthcare Provider Details

I. General information

NPI: 1194960997
Provider Name (Legal Business Name): JENNIFER H WANG DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13502 PADDINGTON CIR
AUSTIN TX
78729-1930
US

IV. Provider business mailing address

13502 PADDINGTON CIR
AUSTIN TX
78729-1930
US

V. Phone/Fax

Practice location:
  • Phone: 877-801-1188
  • Fax: 888-592-3646
Mailing address:
  • Phone: 877-801-1188
  • Fax: 888-592-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1646
License Number StateTX

VIII. Authorized Official

Name: DR. JENNIFER H WANG
Title or Position: PRESIDENT
Credential: DPM
Phone: 877-801-1188