Provider Demographics
NPI:1659850071
Name:TIEN CHUN D. WANG D.M.D., INC
Entity Type:Organization
Organization Name:TIEN CHUN D. WANG D.M.D., INC
Other - Org Name:TIEN CHUN D. WANG D.M.D., INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIEN CHUN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-594-7899
Mailing Address - Street 1:1309 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1317
Mailing Address - Country:US
Mailing Address - Phone:909-594-7899
Mailing Address - Fax:909-839-1168
Practice Address - Street 1:1309 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1317
Practice Address - Country:US
Practice Address - Phone:909-594-7899
Practice Address - Fax:909-839-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty