Jin Wang MD Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

JIN WANG MD INC

Practice address

811 E 11TH St Ste 206
Upland, CA 91786-4872

Phone

(909) 816-6258

NPI assigned

Aug 16, 2023

Last updated

Sep 15, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jin Wang, MDNPI 1154353126

Title

President

Phone

(909) 816-6258

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jin Wang, M.D.

  • Nephrology Physician
  • Upland, CA
  • NPI 1154353126
  Medicare reassignment Authorized official
• Jonardi Handoko, MD

  • Nephrology Physician
  • Upland, CA
  • NPI 1780664581
  NPD (past)
• Tammy Wang

  • Registered Dietitian
  • Claremont, CA
  • NPI 1871995696
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1417730045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 TREVECCA PL",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917111405",
            "telephone_number": "909-816-6258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 E 11TH ST STE 206",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864872",
            "telephone_number": "909-816-6258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIN WANG MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "JIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-816-6258",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Upland, CA
• Providers in Upland, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.