Provider Demographics
NPI:1134940190
Name:ELITE BARIATRIC SURGERY & WELLNESS PC
Entity type:Organization
Organization Name:ELITE BARIATRIC SURGERY & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIN-CHERN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-374-1123
Mailing Address - Street 1:2176 SPRINGFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2856
Mailing Address - Country:US
Mailing Address - Phone:626-374-1123
Mailing Address - Fax:
Practice Address - Street 1:4234 RIVERWALK PKWY STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3371
Practice Address - Country:US
Practice Address - Phone:909-418-2700
Practice Address - Fax:909-220-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty