Basic Information
Provider Information
NPI: 1316175995
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DJAJADI
FirstName: WEI-MIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5865
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794085865
CountryCode: US
TelephoneNumber: 8067432898
FaxNumber: 8067432787
Practice Location
Address1: 3601 4TH ST FL 3
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794300002
CountryCode: US
TelephoneNumber: 8067437335
FaxNumber: 8067434073
Other Information
ProviderEnumerationDate: 06/23/2009
LastUpdateDate: 10/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XP8351TXY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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