Provider Demographics
NPI:1215135496
Name:WANG, XIU-JIE (MD)
Entity type:Individual
Prefix:DR
First Name:XIU-JIE
Middle Name:
Last Name: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:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-2828
Mailing Address - Country:US
Mailing Address - Phone:951-278-8870
Mailing Address - Fax:951-278-8913
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:951-278-8870
Practice Address - Fax:951-278-8913
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4322182086S0129X
CAC1338702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02910089Medicaid
PA1019992240001Medicaid
PAGU039818OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PAP00424200OtherRR MEDICARE PIN
PA1019992240001Medicaid