Healthcare Provider Details

I. General information

NPI: 1689324683
Provider Name (Legal Business Name): COURTNEY WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ # BCM610
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

2582 KELTON AVE
LOS ANGELES CA
90064-3227
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-7354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number207954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: