Individual provider Active NPI

Xin Wang, PA-C

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1083450407
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3108 Issued in NV
Practice address
653 N Town Center Dr Ste 414
Las Vegas, NV 89144-0518
Phone
(702) 456-3120
Fax
(702) 823-1069
NPI assigned
Jul 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA3108 NV Primary

Addresses

Primary practice location

653 N Town Center Dr Ste 414
Las Vegas, NV 89144-0518

Mailing address

309 E 2ND St
Pomona, CA 91766-1854
Phone (909) 623-6116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241113004520 NV Practitioner - Physician Assistant 7416481437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Las Vegas Dermatology PCGroup PAC ID 6204232275, 8 clinicians

Practice addresses (Care Compare)

653 N Town Cedar Dr
Suite 414
Las Vegas, NV 89144-0518
Phone (702) 456-3120

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA3108NVMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1083450407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 N TOWN CENTER DR STE 414",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891440518",
            "telephone_number": "702-456-3120",
            "fax_number": "702-823-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "XIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-04",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA3108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.