Healthcare Provider Details

I. General information

NPI: 1033938766
Provider Name (Legal Business Name): DINAH WAN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S PRESTON RD STE 40
PROSPER TX
75078-3527
US

IV. Provider business mailing address

240 S PRESTON RD STE 40
PROSPER TX
75078-3527
US

V. Phone/Fax

Practice location:
  • Phone: 972-919-0010
  • Fax: 972-919-0014
Mailing address:
  • Phone: 972-919-0010
  • Fax: 972-919-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DINAH WAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 972-919-0010