MEDICARE: DR. IVY X 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	049014	NY

General Provider Information

NPI Number	:	1720078769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVY X WANG D.D.S

Provider Business Mailing Address
First Line	:	2 MOTT ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-5003
Country	:	US
Telephone Number	:	212-732-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MOTT ST
Second Line	:	SUITE #303
City	:	NEW YORK
State	:	NY
Zip	:	10013-5003
Country	:	US
Telephone Number	:	212-732-5875
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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