Provider Demographics
NPI:1396704482
Name:WANG, WEI (MD)
Entity type:Individual
Prefix:
First Name:WEI
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 FOREST AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1448
Mailing Address - Country:US
Mailing Address - Phone:408-216-8763
Mailing Address - Fax:408-416-3706
Practice Address - Street 1:2101 FOREST AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1448
Practice Address - Country:US
Practice Address - Phone:408-216-8763
Practice Address - Fax:408-416-3706
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA914182084S0012X, 2084N0400X, 2084V0102X
IN01055906A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397577OtherPHCS PID NUMBER
IN11385409OtherCAQH NUMBER
IN200374900Medicaid
IN000000221797OtherANTHEM PROVIDER NUMBER
INH63668Medicare UPIN
IN130025325Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
IN224390TMedicare PIN
IN815460TTMedicare PIN