Provider Demographics
NPI:1548443500
Name:WANG, CHING SHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHING
Middle Name:SHAN
Last Name:WANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 BRUNDAGE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2850
Mailing Address - Country:US
Mailing Address - Phone:951-756-6398
Mailing Address - Fax:661-322-2073
Practice Address - Street 1:2021 BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2850
Practice Address - Country:US
Practice Address - Phone:951-756-6398
Practice Address - Fax:661-322-2073
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics