Provider Demographics
NPI:1942447776
Name:WEI, TOM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:WEI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BENSON RD S
Mailing Address - Street 2:211
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4500
Mailing Address - Country:US
Mailing Address - Phone:916-759-0596
Mailing Address - Fax:
Practice Address - Street 1:6715 FORT DENT WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2540
Practice Address - Country:US
Practice Address - Phone:206-248-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10185122300000X
CA57218122300000X
MNS551223E0200X
WADE60471062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics