Healthcare Provider Details

I. General information

NPI: 1720009301
Provider Name (Legal Business Name): NEIL STEVEN WENGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #365,530,420,120
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

200 UCLA MEDICAL PLZ STE 420
LOS ANGELES CA
90095-8344
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-0644
  • Fax: 310-794-0732
Mailing address:
  • Phone: 310-206-6232
  • Fax: 310-206-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG55997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: