Healthcare Provider Details

I. General information

NPI: 1104581370
Provider Name (Legal Business Name): VINCENT W H WANG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

572 E GREEN ST STE 205
PASADENA CA
91101-2075
US

IV. Provider business mailing address

572 E GREEN ST STE 205
PASADENA CA
91101-2075
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: VINCENT WANG
Title or Position: DOCTOR, OWNER
Credential: DDS
Phone: 626-796-2800