Healthcare Provider Details

I. General information

NPI: 1366503385
Provider Name (Legal Business Name): VINCENT WEN-HSIENG WANG D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 E GREEN ST SUITE 205
PASADENA CA
91101-2045
US

IV. Provider business mailing address

572 E GREEN ST SUITE 205
PASADENA CA
91101-2045
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-2800
  • Fax: 626-796-2299
Mailing address:
  • Phone: 626-796-2800
  • Fax: 626-796-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number53739
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: