Basic Information
Provider Information
NPI: 1437808094
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WANG
FirstName: YINGXUE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 THE CITY DR S
Address2: CITY TOWER, STE 400
City: ORANGE
State: CA
PostalCode: 928683562
CountryCode: US
TelephoneNumber: 7144565691
FaxNumber:  
Practice Location
Address1: 101 THE CITY DRIVE
Address2: CITY TOWER, STE 400
City: ORANGE
State: CA
PostalCode: 928683201
CountryCode: US
TelephoneNumber: 7144565691
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/21/2022
LastUpdateDate: 06/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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