Provider Demographics
NPI:1376724005
Name:TIAN, WENQIANG
Entity Type:Individual
Prefix:
First Name:WENQIANG
Middle Name:
Last Name:TIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BARRANCA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1723
Mailing Address - Country:US
Mailing Address - Phone:949-551-1090
Mailing Address - Fax:
Practice Address - Street 1:4050 BARRANCA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1723
Practice Address - Country:US
Practice Address - Phone:949-551-1090
Practice Address - Fax:949-262-5500
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1053622084N0400X
173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No173000000XOther Service ProvidersLegal Medicine