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General NPI Number Information
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NPI Number | 1104581370
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Entity Type | Organization
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Legal Business Name | VINCENT W H WANG DDS INC
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 572 E GREEN ST STE 205
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City | PASADENA
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State | CA
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Zip | 91101-2075
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Country | US
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Telephone | 626-796-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 572 E GREEN ST STE 205
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City | PASADENA
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State | CA
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Zip | 91101-2075
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Country | US
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Telephone | 626-796-2800
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Fax |
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Authorized Official
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Title or Position | DOCTOR, OWNER
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Name | VINCENT WANG
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Credential | DDS
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Telephone | 626-796-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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