Provider Demographics
NPI:1861493058
Name:SU, WEIYANG STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WEIYANG
Middle Name:STANLEY
Last Name:SU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEWBURY RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3613
Mailing Address - Country:US
Mailing Address - Phone:805-375-1611
Mailing Address - Fax:805-375-1655
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 115
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3613
Practice Address - Country:US
Practice Address - Phone:805-375-1611
Practice Address - Fax:805-375-1655
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40181Medicare ID - Type UnspecifiedPROVIDER ID NUMBER