Provider Demographics
NPI:1376561860
Name:WEE, HENRY HEUNG-HWAN (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:HEUNG-HWAN
Last Name:WEE
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:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-0775
Mailing Address - Country:US
Mailing Address - Phone:714-636-0343
Mailing Address - Fax:714-636-0391
Practice Address - Street 1:2701 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6201
Practice Address - Country:US
Practice Address - Phone:714-636-0343
Practice Address - Fax:714-636-0391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31904207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD371ZOtherMEDICARE PTAN
CA00A319040Medicaid
CAA31904Medicare ID - Type Unspecified
CAB50180Medicare UPIN