Healthcare Provider Details

I. General information

NPI: 1477223048
Provider Name (Legal Business Name): WU WEI VITALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 COMMONWEALTH AVE
AUBURNDALE MA
02466-2725
US

IV. Provider business mailing address

1863 COMMONWEALTH AVE
AUBURNDALE MA
02466-2725
US

V. Phone/Fax

Practice location:
  • Phone: 617-968-5138
  • Fax: 617-209-6498
Mailing address:
  • Phone: 617-968-5138
  • Fax: 617-209-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNICE WONG
Title or Position: OWNER
Credential: MD
Phone: 617-968-5138