Provider Demographics
NPI:1093098881
Name:WANG, EDDY Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WHISMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-5267
Mailing Address - Country:US
Mailing Address - Phone:310-622-3388
Mailing Address - Fax:
Practice Address - Street 1:20735 STEVENS CREEK BLVD STE G
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2104
Practice Address - Country:US
Practice Address - Phone:408-725-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice