Provider Demographics
NPI:1558864819
Name:CHARLES WANG DDS, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHARLES WANG DDS, PROFESSIONAL CORPORATION
Other - Org Name:626 DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-579-5158
Mailing Address - Street 1:4900 PECK RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1422
Mailing Address - Country:US
Mailing Address - Phone:626-579-5158
Mailing Address - Fax:626-579-5311
Practice Address - Street 1:4900 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732
Practice Address - Country:US
Practice Address - Phone:626-579-5158
Practice Address - Fax:626-579-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56386261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental