Healthcare Provider Details

I. General information

NPI: 1669263307
Provider Name (Legal Business Name): WESLEY HUNG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11328 KENYON WAY
RANCHO CUCAMONGA CA
91701-9265
US

IV. Provider business mailing address

4995 CERVETTI AVE
RANCHO CUCAMONGA CA
91739-5127
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-5800
  • Fax:
Mailing address:
  • Phone: 951-961-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: WESLEY HUNG
Title or Position: CEO
Credential: DDS
Phone: 951-961-0608