Individual
JEAN C WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3500 GASTON AVENUE, DALLAS, TX 75246
(214) 820-3216
Mailing address
PO BOX 1888, GREENVILLE, TX 75403-1888
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L4794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159134902
—
TX
05
—
159134904
—
TX
Enumeration date
05/22/2006
Last updated
05/08/2008
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