Provider Demographics
NPI:1679782718
Name:SU-MIN WANG PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:SU-MIN WANG PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SU-MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:949-362-9860
Mailing Address - Street 1:24541 PACIFIC PARK DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3050
Mailing Address - Country:US
Mailing Address - Phone:949-362-9860
Mailing Address - Fax:949-362-4802
Practice Address - Street 1:24541 PACIFIC PARK DR STE 104
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3050
Practice Address - Country:US
Practice Address - Phone:949-362-9860
Practice Address - Fax:949-362-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty