MEDICARE: RICHARD WAN-LUNG IP 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	122300000X	Dentist	DY17628	NJ
2	122300000X	Dentist	DS026522Y	PA

General Provider Information

NPI Number	:	1568664043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WAN-LUNG IP DDS

Provider Business Mailing Address
First Line	:	2678 WELSH ROAD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152
Country	:	US
Telephone Number	:	215-673-4017
Fax Number	:	215-677-5772

Provider Business Practice Location Address
First Line	:	2678 WELSH ROAD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152
Country	:	US
Telephone Number	:	215-673-4017
Fax Number	:	215-677-5772

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/24/2026

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