Provider Demographics
NPI:1043219678
Name:WENG, JOSH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:
Last Name:WENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIAXIONG
Other - Middle Name:
Other - Last Name:WENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:#106
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7603
Mailing Address - Country:US
Mailing Address - Phone:626-447-4483
Mailing Address - Fax:626-447-4482
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:#106
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7603
Practice Address - Country:US
Practice Address - Phone:626-447-4483
Practice Address - Fax:626-447-4482
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709651Medicaid
CA00A709651Medicaid
CAA70965Medicare ID - Type Unspecified