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General NPI Number Information
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NPI Number | 1598022097
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Entity Type | Individual
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Provider Name | YA-CHUN WANG
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 22635 NE MARKETPLACE DR STE 110
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City | REDMOND
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State | WA
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Zip | 98053-5898
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Country | US
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Telephone | 425-284-9884
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Fax |
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Provider Business Mailing Address
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Address Line | 22635 NE MARKETPLACE DR STE 110
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City | REDMOND
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State | WA
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Zip | 98053-5898
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Country | US
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Telephone | 425-284-9884
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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 | DE60477545
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License Number State | WA
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