Healthcare Provider Details

I. General information

NPI: 1114811940
Provider Name (Legal Business Name): YIOU WANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

200 SPIREA WAY APT 2112
WARREN NJ
07059-5416
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 701-566-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: