Healthcare Provider Details

I. General information

NPI: 1700227931
Provider Name (Legal Business Name): SHIRLEY LEE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 E FLORIDA AVE
HEMET CA
92543-4510
US

IV. Provider business mailing address

53 FULTON
IRVINE CA
92620-3349
US

V. Phone/Fax

Practice location:
  • Phone: 951-599-8403
  • Fax:
Mailing address:
  • Phone: 949-689-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMT205109
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA142943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: