Provider Demographics
NPI:1043480916
Name:WANG, CHAO WEN (DDS MS PEDIATRIC DEN)
Entity Type:Individual
Prefix:DR
First Name:CHAO WEN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS MS PEDIATRIC DEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 MOWRY AVE STE A4
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1724
Mailing Address - Country:US
Mailing Address - Phone:510-494-9788
Mailing Address - Fax:510-471-7427
Practice Address - Street 1:2147 MOWRY AVE STE A4
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1724
Practice Address - Country:US
Practice Address - Phone:510-494-9788
Practice Address - Fax:510-471-7427
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17846171100000X
CA401271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty