Su-Min Wang Professional Dental Corporation

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

36030 Issued in CA

Legal business name

SU-MIN WANG PROFESSIONAL DENTAL CORPORATION

Practice address

24541 Pacific Park Dr Ste 104
Aliso Viejo, CA 92656-3050

Phone

(949) 362-9860

Fax

(949) 362-4802

NPI assigned

May 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Su-Min Wang, DDS, MSNPI 1134461353

Title

President

Phone

(949) 362-9860

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Su-Min Wang, D.D.S.

  • Pediatric Dentistry
  • Aliso Viejo, CA
  • NPI 1134461353
  NPD (past) Authorized official
• Cima Mazar-Atabaki, D.M.D.

  • Pediatric Dentistry
  • Aliso Viejo, CA
  • NPI 1306075825
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679782718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR STE 104",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563050",
            "telephone_number": "949-362-9860",
            "fax_number": "949-362-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR STE 104",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563050",
            "telephone_number": "949-362-9860",
            "fax_number": "949-362-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SU-MIN WANG PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "SU-MIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-362-9860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "36030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Stillman
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• Dalton Charles Sumrall
• Swan-Rosney Enterprises, LLC (ALLWAYS Home Care)
• Phuong Nicole Ta, M.D.
• Saundra Taggart, M.A. NUTRITION
• Isaac Yitzhak Taitz, PHD

• Pediatric Dentistry in Aliso Viejo, CA
• Providers in Aliso Viejo, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.