Provider Demographics
NPI:1366659203
Name:WEI, ALLEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:J
Last Name:WEI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 LAKE MURRAY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1334
Mailing Address - Country:US
Mailing Address - Phone:619-589-5454
Mailing Address - Fax:
Practice Address - Street 1:5308 LAKE MURRAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1334
Practice Address - Country:US
Practice Address - Phone:619-589-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics