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General NPI Number Information
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NPI Number | 1639345879
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Entity Type | Organization
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Legal Business Name | TIM WANG DDS, INC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 46921 WARM SPRINGS BLVD STE 203
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City | FREMONT
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State | CA
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Zip | 94539-7934
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Country | US
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Telephone | 510-792-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 46921 WARM SPRINGS BLVD STE 203
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City | FREMONT
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State | CA
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Zip | 94539-7934
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Country | US
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Telephone | 510-792-7888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIM TING- CHUN WANG
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Credential | D.D.S.
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Telephone | 510-792-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48405
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License Number State | CA
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