Provider Demographics
NPI:1497812606
Name:WANG, YEN CHUN (DDS)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:CHUN
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 1:6328 E BROWN RD
Mailing Address - Street 2:SUITE 101-102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-325-5700
Mailing Address - Fax:480-325-5727
Practice Address - Street 1:6328 E BROWN RD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4841
Practice Address - Country:US
Practice Address - Phone:480-325-5700
Practice Address - Fax:420-325-5727
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist