Provider Demographics
NPI:1972156727
Name:LEW, WAN HO (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAN HO
Middle Name:
Last Name:LEW
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 1:510 E 80TH ST
Mailing Address - Street 2:OFC 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:929-285-0082
Mailing Address - Fax:
Practice Address - Street 1:510 E 80TH ST
Practice Address - Street 2:OFC 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:646-536-5088
Practice Address - Fax:646-536-5077
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4739122300000X
NY061994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist