Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | Q9076 | TX |
NPI | 1003250457 |
---|---|
Provider Name | Connie Mengyan Wang |
First Address | Katy, TX 77494-6545 |
Second Address | Katy, TX 77494-6545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2013 |
Last Update Date | 05/03/2018 |