Provider Demographics
NPI:1063788222
Name:WEI, JIANDONG (MD)
Entity type:Individual
Prefix:
First Name:JIANDONG
Middle Name:
Last Name:WEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 SENDA PANACEA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2202
Mailing Address - Country:US
Mailing Address - Phone:718-753-5008
Mailing Address - Fax:
Practice Address - Street 1:1000 GREENLEY RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5200
Practice Address - Country:US
Practice Address - Phone:209-536-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282101207R00000X
MN67227208M00000X
CA133632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist