MEDICARE: DR. JANICE JIING 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	122300000X	Dentist	43094	CA

General Provider Information

NPI Number	:	1497961320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE JIING WANG D.D.S.

Provider Business Mailing Address
First Line	:	1050 LARCH AVE
Second Line	:
City	:	MORAGA
State	:	CA
Zip	:	94556-1853
Country	:	US
Telephone Number	:	925-376-7106
Fax Number	:	925-631-0413

Provider Business Practice Location Address
First Line	:	1844 SAN MIGUEL DR STE 202
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-4913
Country	:	US
Telephone Number	:	925-939-0700
Fax Number	:	925-939-0128

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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