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General NPI Number Information
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NPI Number | 1881473411
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Entity Type | Individual
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Provider Name | JONATHAN WANG DDS
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Gender | Male
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 580 N SUNRISE AVE STE 190
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City | ROSEVILLE
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State | CA
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Zip | 95661-2890
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Country | US
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Telephone | 916-772-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 1069 KENDALL DR
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City | SAN GABRIEL
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State | CA
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Zip | 91775-2710
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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 |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DDS108810
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License Number State | CA
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