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General NPI Number Information
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NPI Number | 1407359334
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Entity Type | Individual
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Provider Name | DR. LI JEN WANG
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Gender | Male
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 19718 68TH AVE W STE G
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City | LYNNWOOD
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State | WA
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Zip | 98036-5965
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Country | US
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Telephone | 425-778-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 3331 159TH LN SW
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City | LYNNWOOD
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State | WA
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Zip | 98087-1545
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Country | US
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Telephone | 206-979-1373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DR60850394
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60894468
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License Number State | WA
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