Provider Demographics
NPI:1275559288
Name:WANG, DEJUN (MD)
Entity Type:Individual
Prefix:
First Name:DEJUN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 COLIMA RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3074
Mailing Address - Country:US
Mailing Address - Phone:626-810-2983
Mailing Address - Fax:626-810-5741
Practice Address - Street 1:19115 COLIMA RD UNIT 104
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3074
Practice Address - Country:US
Practice Address - Phone:626-810-2983
Practice Address - Fax:626-810-5741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29793Medicare UPIN