Healthcare Provider Details

I. General information

NPI: 1972102374
Provider Name (Legal Business Name): KAIZHEN WANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/22/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 NORTH LOOP W STE 299
HOUSTON TX
77008-1368
US

IV. Provider business mailing address

1919 NORTH LOOP W STE 299
HOUSTON TX
77008-1368
US

V. Phone/Fax

Practice location:
  • Phone: 713-955-7345
  • Fax: 832-648-7747
Mailing address:
  • Phone: 713-955-7345
  • Fax: 832-648-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1006448
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: