Provider Demographics
NPI:1376625665
Name:WANG, CHONG-SHU (DMD)
Entity Type:Individual
Prefix:MR
First Name:CHONG-SHU
Middle Name:
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 1:13081 STANTON
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2249
Mailing Address - Country:US
Mailing Address - Phone:714-744-6991
Mailing Address - Fax:
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:#130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3600
Practice Address - Country:US
Practice Address - Phone:949-551-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 340111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice