Jerry Wang, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

40200 Issued in CA

Practice address

1475 Cedarwood LN Ste a
Pleasanton, CA 94566-6128

Phone

(925) 426-1600

Fax

(925) 426-1601

NPI assigned

Nov 1, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 5, 2019 through Mar 5, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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.

• Northern California Facial and Oral Surgery Centers

  • Dentist
  • San Leandro, CA
  • NPI 1780984252
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1639257330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 CEDARWOOD LN STE A",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945666128",
            "telephone_number": "925-426-1600",
            "fax_number": "925-426-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 CEDARWOOD LN STE A",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945666128",
            "telephone_number": "925-426-1600",
            "fax_number": "925-426-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JERRY",
        "name_prefix": "Mr.",
        "credential": "DDS MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "40200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@wangoralsurgery.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1475 Cedarwood Ln Ste A",
            "city": "Pleasanton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945666128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teresa Lynn Walsh, PTA
• Yahdira Waltman
• Carolyn Wanczyk, PT
• Ariel Wang
• Changying Wang
• Ruiyu Wang, PHARM D
• Shiyin Linda Wang
• Ting Wang, MD
• Iris Alexandra Warchall, D.P.T.
• Benjamin D Ward

• Oral and Maxillofacial Surgery (Dentist) in Pleasanton, CA
• Providers in Pleasanton, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.