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General NPI Number Information
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NPI Number | 1194930982
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Entity Type | Organization
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Legal Business Name | JIMMY I. WANG, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10432 RESERVE DRIVE SUITE 110
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City | SAN DIEGO
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State | CA
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Zip | 92127
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Country | US
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Telephone | 858-487-6428
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Fax |
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Provider Business Mailing Address
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Address Line | 11775 SCRIPPS LAKE DR
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City | SAN DIEGO
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State | CA
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Zip | 92131-2374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JIMMY I WANG
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Credential | DDS
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Telephone | 858-487-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 51387
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License Number State | CA
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