Provider Demographics
NPI:1710037197
Name:WEE, ERIC (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 TOPANGA CANYON BLVD
Mailing Address - Street 2:STE 109
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3345
Mailing Address - Country:US
Mailing Address - Phone:310-963-6229
Mailing Address - Fax:
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5724
Practice Address - Country:US
Practice Address - Phone:310-963-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41611Medicaid
CA000E41610Medicaid
CA000E41611Medicaid
CAU71204Medicare UPIN
CAE4161Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER