Provider Demographics
NPI:1255759007
Name:TIAN, WEI (BMED, MSD, PHD)
Entity type:Individual
Prefix:
First Name:WEI
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:BMED, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22330 NE MARKETPLACE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2071
Mailing Address - Country:US
Mailing Address - Phone:206-251-6913
Mailing Address - Fax:
Practice Address - Street 1:22330 NE MARKETPLACE DR STE 117
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2071
Practice Address - Country:US
Practice Address - Phone:425-202-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603285311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics