Provider Demographics
NPI:1396184685
Name:LEE-WANG, CANDICE JI EUN (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:JI EUN
Last Name:LEE-WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 N. HIGHLAND SPRINGS
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-769-0079
Mailing Address - Fax:888-854-7592
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE STE 4
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-769-0079
Practice Address - Fax:888-854-7592
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine