Provider Demographics
NPI:1679531594
Name:WANG, XUECHENG
Entity type:Individual
Prefix:
First Name:XUECHENG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8 MEDICAL PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7859
Mailing Address - Country:US
Mailing Address - Phone:972-481-1881
Mailing Address - Fax:
Practice Address - Street 1:8 MEDICAL PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7859
Practice Address - Country:US
Practice Address - Phone:972-481-1881
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG32187Medicare UPIN
TX00424LMedicare ID - Type Unspecified