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General NPI Number Information
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NPI Number | 1538630959
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Entity Type | Organization
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Legal Business Name | JFK WANG DDS CORP
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 7071 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504
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Country | US
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Telephone | 714-363-6928
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Fax |
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Provider Business Mailing Address
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Address Line | 54 TUNDRA
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City | IRVINE
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State | CA
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Zip | 92602-1847
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Country | US
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Telephone | 714-363-6928
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RAYMOND S WANG
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Credential | DDS
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Telephone | 714-363-6928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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