Provider Demographics
NPI:1659038602
Name:WEI, BRENDON CHINGLUN (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:CHINGLUN
Last Name:WEI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 GOSHEN AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7311
Mailing Address - Country:US
Mailing Address - Phone:562-652-6722
Mailing Address - Fax:
Practice Address - Street 1:9675 BRIGHTON WAY STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5180
Practice Address - Country:US
Practice Address - Phone:310-278-5337
Practice Address - Fax:310-278-6204
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist