Provider Demographics
NPI:1972624435
Name:WENG, VICTOR K (DO)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:K
Last Name:WENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KUO CHEN
Other - Middle Name:
Other - Last Name:WENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:562-869-4497
Mailing Address - Fax:562-869-6317
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-869-4497
Practice Address - Fax:562-869-6317
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016625207R00000X
CA20A10594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH046ZMedicare PIN