Healthcare Provider Details

I. General information

NPI: 1770103111
Provider Name (Legal Business Name): WEIJIAN CODY LUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CODY LUNG CODY LUNG DDS

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 WOODSIDE RD SUITE 100
REDWOOD CITY CA
94061
US

IV. Provider business mailing address

1733 WOODSIDE RD SUITE 100
REDWOOD CITY CA
94061
US

V. Phone/Fax

Practice location:
  • Phone: 650-716-4888
  • Fax:
Mailing address:
  • Phone: 650-716-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: