Provider Demographics
NPI:1659797454
Name:WEI, WEN
Entity Type:Individual
Prefix:
First Name:WEN
Middle Name:
Last Name:WEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 MISSION ST APT 18S
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-4033
Mailing Address - Country:US
Mailing Address - Phone:310-728-9791
Mailing Address - Fax:
Practice Address - Street 1:950 N ORANGE GROVE AVE APT 4
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-7278
Practice Address - Country:US
Practice Address - Phone:617-820-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321707171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor