1407991979 NPI number — DR. JEAN YI WANG DDS

Table of content: DR. JEAN YI WANG DDS (NPI 1407991979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407991979 NPI number — DR. JEAN YI WANG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
JEAN
Provider Middle Name:
YI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407991979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4141 S. NOGALES ST
Provider Second Line Business Mailing Address:
SUITE B103
Provider Business Mailing Address City Name:
WEST COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91792-3057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-935-5822
Provider Business Mailing Address Fax Number:
626-935-5622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 S. NOGALES ST
Provider Second Line Business Practice Location Address:
SUITE B103
Provider Business Practice Location Address City Name:
WEST COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91792-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-935-5822
Provider Business Practice Location Address Fax Number:
626-935-5622
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  43296 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 43296 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)