MEDICARE: DR. SUNG-WEN KEN WANG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26169	TX

General Provider Information

NPI Number	:	1437391075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNG-WEN KEN WANG DDS

Provider Business Mailing Address
First Line	:	5020 FM 1960 RD W
Second Line	:	SUITE B1
City	:	HOUSTON
State	:	TX
Zip	:	77069-4519
Country	:	US
Telephone Number	:	281-893-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 FM 1960 RD W
Second Line	:	SUITE B1
City	:	HOUSTON
State	:	TX
Zip	:	77069-4519
Country	:	US
Telephone Number	:	281-893-3255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2009
Last Update Date	:	12/20/2010

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