Provider Demographics
NPI:1447348164
Name:WANG, BENNY SHANGPIN (MD)
Entity type:Individual
Prefix:
First Name:BENNY
Middle Name:SHANGPIN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17191 ST LUKES WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8043
Mailing Address - Country:US
Mailing Address - Phone:832-510-6553
Mailing Address - Fax:866-936-7076
Practice Address - Street 1:17191 ST LUKES WAY STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8043
Practice Address - Country:US
Practice Address - Phone:832-510-6553
Practice Address - Fax:866-936-7076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL59472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158692701Medicaid
GAP00018875Medicare PIN
TX8A5835Medicare PIN
TX158692701Medicaid