Active NPI
Le Leila Wang, DMD, PH.D
- Periodontics
- Austin, TX
National Provider Identifier
1811558356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 35901
- Practice address
- 10123 Lake Creek Pkwy BLDG 1
Austin, TX 78729-1755 - Phone
- (413) 835-5934
- NPI assigned
- Jun 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 35901 | TX | Primary |
Addresses
Primary practice location
10123 Lake Creek Pkwy BLDG 1
Austin, TX 78729-1755
Mailing address
12316 Carlsbad Dr
Austin, TX 78738-5334
Phone (413) 835-5934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35901 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1811558356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12316 CARLSBAD DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787385334",
"telephone_number": "413-835-5934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10123 LAKE CREEK PKWY BLDG 1",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787291755",
"telephone_number": "413-835-5934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "LE",
"middle_name": "LEILA",
"name_prefix": "Dr.",
"credential": "DMD, PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-25",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "35901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.