Healthcare Provider Details

I. General information

NPI: 1336171404
Provider Name (Legal Business Name): ZHIJUN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ODYSSEY SUITE 105
IRVINE CA
92618-3186
US

IV. Provider business mailing address

22 ODYSSEY SUITE 105
IRVINE CA
92618-3186
US

V. Phone/Fax

Practice location:
  • Phone: 949-733-0988
  • Fax: 949-733-0972
Mailing address:
  • Phone: 949-733-0988
  • Fax: 949-733-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: