Provider Demographics
NPI:1699867226
Name:CHAN, WEI WU (DDS, MS)
Entity type:Individual
Prefix:
First Name:WEI
Middle Name:WU
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:10910 RUSH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3545
Mailing Address - Country:US
Mailing Address - Phone:626-448-1678
Mailing Address - Fax:626-448-0100
Practice Address - Street 1:10910 RUSH ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3545
Practice Address - Country:US
Practice Address - Phone:626-448-1678
Practice Address - Fax:626-448-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB467611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice