=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447128186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTON PRIMARY MEDICAL CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7712 SAN JACINTO PL STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-669-1212
-----------------------------------------------------
Fax | 972-669-1313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7712 SAN JACINTO PL STE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-669-1212
-----------------------------------------------------
Fax | 972-669-1313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | FANG WANG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 214-663-4029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------