Edward Wang

Primary specialty

DentistTaxonomy code 122300000X

License

110975 Issued in CA

Practice address

1408 S San Gabriel Blvd
San Gabriel, CA 91776-3603

Phone

(626) 572-7211

NPI assigned

Nov 15, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tom Keh Jens Wang a Professional Dental Corp

  • General Practice Dentistry
  • San Gabriel, CA
  • NPI 1699897223
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1093530073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 S SAN GABRIEL BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763603",
            "telephone_number": "626-382-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 S SAN GABRIEL BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763603",
            "telephone_number": "626-572-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "110975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sze Man Wah, NP
• Walgreen Co
• Zhijing ZW Wan, AC20119
• Alice Wang, LMFT
• Chun Yeh Wang, MD.,PH.D.
• Fang Rong Wang, M.D.
• Gavin Wang, L.AC.
• Helen Wang
• Kehjenq Wang, DDS
• Lingli Wang, DDS, MS, PHD

• Dentist in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.