Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OP61165771 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | OP61165771 | WA |
NPI | 1285014571 |
---|---|
Provider Name | Brandon Wei |
First Address | Lumberton, NC 28358-3075 |
Second Address | Kenmore, WA 98028-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 15/09/2021 |