Healthcare Provider Details

I. General information

NPI: 1477891901
Provider Name (Legal Business Name): DR WW DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8516 QUEENS BLVD FL 1
ELMHURST NY
11373-4249
US

IV. Provider business mailing address

8516 QUEENS BLVD FL 1
ELMHURST NY
11373-4249
US

V. Phone/Fax

Practice location:
  • Phone: 718-457-0002
  • Fax: 718-457-0700
Mailing address:
  • Phone: 718-457-0002
  • Fax: 718-457-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014078
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014997
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number215477
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number218668
License Number StateNY

VIII. Authorized Official

Name: DR. HUACHEN WEI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-457-0002