Provider Demographics
NPI:1679634885
Name:WANG, QIANMIN
Entity Type:Individual
Prefix:DR
First Name:QIANMIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7654
Mailing Address - Country:US
Mailing Address - Phone:510-861-0928
Mailing Address - Fax:
Practice Address - Street 1:1129 W 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4477
Practice Address - Country:US
Practice Address - Phone:559-395-4337
Practice Address - Fax:559-395-4602
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice