Provider Demographics
NPI:1245630722
Name:CHEN, WEI
Entity type:Individual
Prefix:
First Name:WEI
Middle Name:
Last Name:CHEN
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 1:1801 W ROMNEYA DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1830
Mailing Address - Country:US
Mailing Address - Phone:714-999-1465
Mailing Address - Fax:714-999-1701
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-999-1465
Practice Address - Fax:714-999-1701
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001513363L00000X
NCAG0614075261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner