Healthcare Provider Details

I. General information

NPI: 1104040468
Provider Name (Legal Business Name): WEN SHENG WANG DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 6TH ST
LOS ANGELES CA
90017-1003
US

IV. Provider business mailing address

1725 W 6TH ST
LOS ANGELES CA
90017-1003
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax: 213-413-7171
Mailing address:
  • Phone: 213-413-5151
  • Fax: 213-413-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48678
License Number StateCA

VIII. Authorized Official

Name: WEN WANG
Title or Position: OWNER
Credential:
Phone: 213-413-5151