Basic Information
Provider Information
NPI: 1790918373
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEN
FirstName: WEN-HSIANG
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6655 NORTH MACARTHUR BLVD.
Address2: 3RD FLOOR
City: IRVING
State: TX
PostalCode: 750392443
CountryCode: US
TelephoneNumber: 6024647500
FaxNumber:  
Practice Location
Address1: 4610 SOUTH 44TH PLACE
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850404010
CountryCode: US
TelephoneNumber: 6024647500
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/28/2009
LastUpdateDate: 12/03/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X42302AZY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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