Jian Wang, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

K6737 Issued in TX

Practice address

4100 Fairway Dr
Suite 300
Carrollton, TX 75010-6525

Phone

(972) 492-8880

Fax

(972) 492-8818

NPI assigned

Dec 9, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Fairway Pediatrics, PLLC

  • Pediatrics Physician
  • Carrollton, TX
  • NPI 1821340472
  NPD (past) Authorized official

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357516800000",
    "number": "1528043882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 FAIRWAY DR",
            "address_2": "SUITE 300",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106525",
            "telephone_number": "972-492-8880",
            "fax_number": "972-492-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 FAIRWAY DR",
            "address_2": "SUITE 300",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106525",
            "telephone_number": "972-492-8880",
            "fax_number": "972-492-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JIAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-09",
        "last_updated": "2013-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K6737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1075004-14",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "84677F",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James S. Wallace, D.D.S.
• Martha E Wallace, PT, DPT
• Lori Deann Walsh
• Robin Neal Walters, DOCTOR OF PHARMACY
• Chong Wang, PHD
• Deborah F Wardell, M.D.
• Abigail Ware
• Amanda M Warneke
• Warr on Wellness, LLC
• Angela Faye Warr, AMS

• Pediatrics Physician in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.