Healthcare Provider Details

I. General information

NPI: 1841483336
Provider Name (Legal Business Name): WESLEY KWAN LEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 W SUNSET BLVD GENERAL SURGERY 3RD FLOOR
LOS ANGELES CA
90027-6063
US

IV. Provider business mailing address

4760 W SUNSET BLVD GENERAL SURGERY 3RD FLOOR
LOS ANGELES CA
90027-6063
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-5674
  • Fax:
Mailing address:
  • Phone: 323-783-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: