Provider Demographics
NPI:1447864301
Name:WANG, RUEI-HUA (DDS)
Entity type:Individual
Prefix:
First Name:RUEI-HUA
Middle Name:
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 1:1545 116TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3813
Mailing Address - Country:US
Mailing Address - Phone:425-247-3629
Mailing Address - Fax:
Practice Address - Street 1:1545 116TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3813
Practice Address - Country:US
Practice Address - Phone:425-247-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE610846221223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice