Provider Demographics
NPI:1407991979
Name:WANG, JEAN YI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:YI
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 1:4141 S. NOGALES ST
Mailing Address - Street 2:SUITE B103
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3057
Mailing Address - Country:US
Mailing Address - Phone:626-935-5822
Mailing Address - Fax:626-935-5622
Practice Address - Street 1:4141 S. NOGALES ST
Practice Address - Street 2:SUITE B103
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3057
Practice Address - Country:US
Practice Address - Phone:626-935-5822
Practice Address - Fax:626-935-5622
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432961223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist