Provider Demographics
NPI:1235533605
Name:KING, WEI (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WEI
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 PLAZA DEL AMO UNIT 468
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-8909
Mailing Address - Country:US
Mailing Address - Phone:626-864-5464
Mailing Address - Fax:
Practice Address - Street 1:23601 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-257-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30401122300000X
CA1017311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30401OtherTEXAS STATE BOARD OF DENTAL EXAMINERS
CA101731OtherDENTAL BOARD OF CALIFORNIA