Provider Demographics
NPI:1336171404
Name:WANG, ZHIJUN (MD)
Entity type:Individual
Prefix:MR
First Name:ZHIJUN
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 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-733-0988
Mailing Address - Fax:949-733-0972
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-733-0988
Practice Address - Fax:949-733-0972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72665208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A726652Medicaid
CAWA72665CMedicare ID - Type Unspecified
CA00A726652Medicaid