Provider Demographics
NPI:1285603514
Name:WEI, ALAN SHOU-REN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SHOU-REN
Last Name:WEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:S
Other - Last Name:WEI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:32 TIERRA VERDE CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4857
Mailing Address - Country:US
Mailing Address - Phone:925-939-2286
Mailing Address - Fax:
Practice Address - Street 1:2240 GLADSTONE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5126
Practice Address - Country:US
Practice Address - Phone:925-439-1077
Practice Address - Fax:925-439-1179
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A347770Medicaid
CA00A347770Medicaid
CAA27578Medicare UPIN