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General NPI Number Information
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NPI Number | 1578432605
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Entity Type | Organization
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Legal Business Name | AUDREY WANG DDS CORPORATION
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 4765 CARMEL MOUNTAIN RD STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92130-6657
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Country | US
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Telephone | 858-925-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 4765 CARMEL MOUNTAIN RD STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92130-6657
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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 | PERIODONTIST
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Name | DR. AUDREY WANG
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Credential | DDS
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Telephone | 858-472-3695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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