Healthcare Provider Details

I. General information

NPI: 1699620245
Provider Name (Legal Business Name): ELLIS WENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 FOLSOM ST # 4
SAN FRANCISCO CA
94107-1123
US

IV. Provider business mailing address

862 FOLSOM ST # 4
SAN FRANCISCO CA
94107-1123
US

V. Phone/Fax

Practice location:
  • Phone: 650-336-5745
  • Fax:
Mailing address:
  • Phone: 650-336-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number94559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: