MEDICARE: JEFFREY WANG

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	49705	CA

General Provider Information

NPI Number	:	1861880619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WANG

Provider Business Mailing Address
First Line	:	34420 FREMONT BLVD STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-3323
Country	:	US
Telephone Number	:	510-791-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	34420 FREMONT BLVD STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-3323
Country	:	US
Telephone Number	:	510-791-2080
Fax Number	:

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

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	01/02/2015

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Directions to “ JEFFREY WANG ” Practice Location

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