Healthcare Provider Details

I. General information

NPI: 1336254655
Provider Name (Legal Business Name): HAINI WANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 34TH ST SUITE 1M
NEW YORK NY
10016-4977
US

IV. Provider business mailing address

333 E 34TH ST SUITE 1M
NEW YORK NY
10016-4977
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-8625
  • Fax: 212-725-4753
Mailing address:
  • Phone: 212-686-8625
  • Fax: 212-725-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number045687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: