MEDICARE: DAVID XUDONG WANG D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	51313	CA

General Provider Information

NPI Number	:	1467520411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID XUDONG WANG D.D.S

Provider Business Mailing Address
First Line	:	4185 VIA CANDIDIZ
Second Line	:	#12
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2185
Country	:	US
Telephone Number	:	858-481-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1418
Country	:	US
Telephone Number	:	619-521-0012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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