Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 16185 | MD |
NPI | 1780090464 |
---|---|
Provider Name | Lun Wang |
First Address | Westminster, MD 21157-5333 |
Second Address | Westminster, MD 21157-5333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 19/08/2020 |