Provider Demographics
NPI:1437597119
Name:WELLNESS FOOT AND ANKLE SURGERY CLINIC INC
Entity Type:Organization
Organization Name:WELLNESS FOOT AND ANKLE SURGERY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:CHEUNG
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-288-8671
Mailing Address - Street 1:9310 VALLEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1924
Mailing Address - Country:US
Mailing Address - Phone:626-288-8671
Mailing Address - Fax:
Practice Address - Street 1:9310 VALLEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1924
Practice Address - Country:US
Practice Address - Phone:626-288-8671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5066213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty