Provider Demographics
NPI:1386686889
Name:SHOW, WEI DER (MD)
Entity Type:Individual
Prefix:
First Name:WEI DER
Middle Name:
Last Name:SHOW
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 1:3301 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1931
Mailing Address - Country:US
Mailing Address - Phone:323-225-2351
Mailing Address - Fax:323-225-7555
Practice Address - Street 1:3301 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1931
Practice Address - Country:US
Practice Address - Phone:323-225-2351
Practice Address - Fax:323-225-7555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480480Medicaid
CA00A480480Medicaid
CAE47712Medicare UPIN