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General NPI Number Information
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NPI Number | 1750646865
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Entity Type | Organization
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Legal Business Name | VICKI H. WANG DENTAL CORPORATION
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 1282 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91104-2854
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Country | US
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Telephone | 626-797-3451
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Fax | 626-797-3431
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Provider Business Mailing Address
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Address Line | 1282 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91104-2854
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Country | US
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Telephone | 626-797-3451
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Fax | 626-797-3431
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICKI HYUNA WANG
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Credential | DDS
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Telephone | 626-797-3451
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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 | 47206
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License Number State | CA
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