Healthcare Provider Details

I. General information

NPI: 1700019569
Provider Name (Legal Business Name): SHIN-CHERN WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 120
RIVERSIDE CA
92505-3304
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 120
RIVERSIDE CA
92505-3304
US

V. Phone/Fax

Practice location:
  • Phone: 909-418-2700
  • Fax:
Mailing address:
  • Phone: 909-418-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberA116864
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA116864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: