Provider Demographics
NPI:1770651143
Name:DANIEL WANG AND RONNIE CHEN PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:DANIEL WANG AND RONNIE CHEN PROFESSIONAL DENTAL CORP.
Other - Org Name:LAI LAI DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-288-9011
Mailing Address - Street 1:116 E. EMERSON AVE,.
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755
Mailing Address - Country:US
Mailing Address - Phone:626-288-9011
Mailing Address - Fax:626-288-9013
Practice Address - Street 1:116 E. EMERSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755
Practice Address - Country:US
Practice Address - Phone:626-288-9011
Practice Address - Fax:626-288-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9399601OtherMEDI CAL