Provider Demographics
NPI:1982998043
Name:WEI DOHERTY, JILL TSUYUNG (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TSUYUNG
Last Name:WEI DOHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:T
Other - Last Name:WEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 WILSHIRE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1854
Mailing Address - Country:US
Mailing Address - Phone:310-829-8908
Mailing Address - Fax:424-212-5931
Practice Address - Street 1:901 WILSHIRE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1854
Practice Address - Country:US
Practice Address - Phone:310-829-8908
Practice Address - Fax:424-212-5931
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine