MEDICARE: NAI-HUEI 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	1223P0700X	Prosthodontics	33401	CA

General Provider Information

NPI Number	:	1649302068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAI-HUEI WANG D.D.S.

Provider Business Mailing Address
First Line	:	1260 15TH ST STE 1002
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1145
Country	:	US
Telephone Number	:	310-394-1289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 15TH ST STE 1002
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1145
Country	:	US
Telephone Number	:	310-394-1289
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/23/2019

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