Audrey Wang, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

111004 Issued in CA

Practice address

4765 Carmel Mountain Rd Ste 204
San Diego, CA 92130-6657

Phone

(858) 259-1168

NPI assigned

Jun 22, 2017

Sex

Female

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

Locations

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.

• Audrey Wang DDS Corporation

  • Periodontics
  • San Diego, CA
  • NPI 1578432605
  NPD Authorized official

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1184144867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4765 CARMEL MOUNTAIN RD STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 CARMEL MOUNTAIN RD STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306657",
            "telephone_number": "858-259-1168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "AUDREY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "111004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam B Wang, M.D.
• Andrew Ming-Yu Wang, M.D.
• Angela C. Wang, M.D.
• Anita Kaiwei Wang, PHARMD
• Annie Wang
• Ben Wang, L.AC., O.M.D.
• Carolyn Wang, DDS
• Carolyn Wang
• Cassandra Wang
• Christine M Wang, M.D.

• Periodontics in San Diego, CA
• Providers in San Diego, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.