Healthcare Provider Details

I. General information

NPI: 1346918000
Provider Name (Legal Business Name): TYLER CHRISTOPHER WEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 SANTA MONICA BLVD STE 200
LOS ANGELES CA
90025-5007
US

IV. Provider business mailing address

4969 DUNMAN AVE
WOODLAND HILLS CA
91364-2720
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-5984
  • Fax:
Mailing address:
  • Phone: 818-517-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: