Provider Demographics
NPI:1659575207
Name:WANG, PAUL I-CHUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:I-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 1:218 ELWORTHY RANCH DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4845
Mailing Address - Country:US
Mailing Address - Phone:415-760-9169
Mailing Address - Fax:
Practice Address - Street 1:115 BERKELEY SQ
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1206
Practice Address - Country:US
Practice Address - Phone:510-982-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19750122300000X, 1223G0001X
CA635131223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice