Provider Demographics
NPI:1689788473
Name:WANG, CHUCK CY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUCK
Middle Name:CY
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 1:1134 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1404
Mailing Address - Country:US
Mailing Address - Phone:310-274-6089
Mailing Address - Fax:323-272-3617
Practice Address - Street 1:1134 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1404
Practice Address - Country:US
Practice Address - Phone:310-274-6089
Practice Address - Fax:323-272-3617
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice