Healthcare Provider Details

I. General information

NPI: 1063359586
Provider Name (Legal Business Name): JOHN LEE WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOMA LINDA UNIVERSITY 11262 CAMPUS STREET WEST HALL
LOMA LINDA CA
92350-0001
US

IV. Provider business mailing address

LOMA LINDA UNIVERSITY 11262 CAMPUS STREET WEST HALL
LOMA LINDA CA
92350-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: