Provider Demographics
NPI:1407888944
Name:WENG, MODERN (DO)
Entity Type:Individual
Prefix:
First Name:MODERN
Middle Name:
Last Name:WENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:746 THE ALAMEDA
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3154
Mailing Address - Country:US
Mailing Address - Phone:408-228-1020
Mailing Address - Fax:408-228-1021
Practice Address - Street 1:1600 AMPHITHEATRE PKWY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1351
Practice Address - Country:US
Practice Address - Phone:650-227-1102
Practice Address - Fax:650-227-1107
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226739207R00000X
CA20A10477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine