Healthcare Provider Details

I. General information

NPI: 1215135496
Provider Name (Legal Business Name): XIU-JIE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR SUITE 105
RIVERSIDE CA
92505-3081
US

IV. Provider business mailing address

PO BOX 2828
CORONA CA
92878-2828
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-8870
  • Fax: 951-278-8913
Mailing address:
  • Phone: 951-278-8870
  • Fax: 951-278-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD432218
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC133870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: