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General NPI Number Information
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NPI Number | 1164171732
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Entity Type | Individual
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Provider Name | LI WAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 2609 SAGEBRUSH DR STE 101
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City | FLOWER MOUND
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State | TX
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Zip | 75028-4670
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Country | US
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Telephone | 972-539-4875
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Fax | 972-539-3488
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Provider Business Mailing Address
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Address Line | 11457 CLOVER KNOLL DR
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City | FRISCO
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State | TX
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Zip | 75035-8608
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Country | US
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Telephone | 512-545-7837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V3138
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License Number State | TX
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