Healthcare Provider Details

I. General information

NPI: 1154206886
Provider Name (Legal Business Name): ASHLEY WANG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ENCINITAS BLVD STE 100
ENCINITAS CA
92024-2844
US

IV. Provider business mailing address

1340 ENCINITAS BLVD STE 100
ENCINITAS CA
92024-2844
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS112074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: