Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 40127 | CA |
NPI | 1043480916 |
---|---|
Provider Name | Dr. Chao Wen Wang |
First Address | Fremont, CA 94538-1724 |
Second Address | Fremont, CA 94538-1724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 10/10/2018 |