1316011372 NPI number — CHAOWEN WANG DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316011372 NPI number — CHAOWEN WANG DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAOWEN WANG DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316011372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24700 CALAROGA AVE
Provider Second Line Business Mailing Address:
STE #104
Provider Business Mailing Address City Name:
HAYWARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94545-2160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-785-9295
Provider Business Mailing Address Fax Number:
510-785-9412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24700 CALAROGA AVE
Provider Second Line Business Practice Location Address:
STE #104
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94545-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-785-9295
Provider Business Practice Location Address Fax Number:
510-785-9412
Provider Enumeration Date:
11/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
CHAOWEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
510-785-9295

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  40127 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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