Basic Information
| Provider Information | |||||||||
| NPI: | 1063788222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEI | ||||||||
| FirstName: | JIANDONG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12516 SENDA PANACEA | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921292202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187535008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 GREENLEY RD | ||||||||
| Address2: | |||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953705200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095365000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2012 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 282101 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 67227 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 133632 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.