Healthcare Provider Details

I. General information

NPI: 1598131112
Provider Name (Legal Business Name): ZHEN HUI WUNG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 MAIN ST STE 150
HESPERIA CA
92345-9130
US

IV. Provider business mailing address

PO BOX 522
LOMA LINDA CA
92354-0522
US

V. Phone/Fax

Practice location:
  • Phone: 760-947-9853
  • Fax:
Mailing address:
  • Phone: 951-878-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: