Active NPI
Tzicha Jessica Wang
- Periodontics
- Philadelphia, PA
National Provider Identifier
1558048264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DS042771
- Practice address
- 2137 Welsh Rd Ste 2a
Philadelphia, PA 19115-4963 - Phone
- (215) 676-0717
- NPI assigned
- Jul 4, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DS042771 | PA | Primary |
Addresses
Primary practice location
2137 Welsh Rd Ste 2a
Philadelphia, PA 19115-4963
Mailing address
2200 Benjamin Franklin Pkwy Apt W1712
Philadelphia, PA 19130-3670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS042771 | PA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontal Services, LTD | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Periodontics
- Philadelphia, PA
- NPI 1285752741
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689206400000",
"number": "1558048264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 BENJAMIN FRANKLIN PKWY APT W1712",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191303670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2137 WELSH RD STE 2A",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191154963",
"telephone_number": "215-676-0717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANG",
"first_name": "TZICHA",
"middle_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-04",
"last_updated": "2023-07-13",
"certification_date": "2023-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "PA",
"license": "DS042771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.