Provider Demographics
NPI:1376762518
Name:WANG, ROSEMARY WEI WEI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:WEI WEI
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 POLLARD RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-379-0885
Mailing Address - Fax:408-379-1782
Practice Address - Street 1:812 POLLARD RD
Practice Address - Street 2:SUITE #8
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-379-0885
Practice Address - Fax:408-379-1782
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38620Medicaid