MEDICARE: ELITE BARIATRIC SURGERY & WELLNESS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1134940190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE BARIATRIC SURGERY & WELLNESS PC

Provider Business Mailing Address
First Line	:	4234 RIVERWALK PKWY STE 120
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3304
Country	:	US
Telephone Number	:	909-418-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4234 RIVERWALK PKWY STE 120
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3304
Country	:	US
Telephone Number	:	909-418-2700
Fax Number	:	909-220-5612

Authorized Official
Title or Position	:	CEO
Name	:	SHIN-CHERN WANG
Credential	:	MD
Telephone Number	:	626-374-1123

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	02/18/2026

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