Provider Demographics
NPI:1366503385
Name:WANG, VINCENT WEN-HSIENG (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:WEN-HSIENG
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 E GREEN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2045
Mailing Address - Country:US
Mailing Address - Phone:626-796-2800
Mailing Address - Fax:626-796-2299
Practice Address - Street 1:572 E GREEN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2045
Practice Address - Country:US
Practice Address - Phone:626-796-2800
Practice Address - Fax:626-796-2299
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53739122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist