=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033938766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DINAH WAN, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2024
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 S PRESTON RD STE 40
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-919-0010
-----------------------------------------------------
Fax | 972-919-0014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 S PRESTON RD STE 40
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-919-0010
-----------------------------------------------------
Fax | 972-919-0014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DINAH WAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-919-0010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------