Provider Demographics
NPI:1770103111
Name:LUNG, WEIJIAN GENRY
Entity type:Individual
Prefix:
First Name:WEIJIAN
Middle Name:GENRY
Last Name:LUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:LUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:173 CAPTAIN NURSE CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6436
Mailing Address - Country:US
Mailing Address - Phone:415-686-5925
Mailing Address - Fax:
Practice Address - Street 1:290 N WAYTE LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-459-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program