Healthcare Provider Details

I. General information

NPI: 1649480252
Provider Name (Legal Business Name): FRANCES I-CHIEN WANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29300 KOHOUTEK WAY STE 100
UNION CITY CA
94587-1220
US

IV. Provider business mailing address

29300 KOHOUTEK WAY STE 100
UNION CITY CA
94587-1220
US

V. Phone/Fax

Practice location:
  • Phone: 510-324-4411
  • Fax:
Mailing address:
  • Phone: 510-324-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: