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General NPI Number Information
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NPI Number | 1437597119
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Entity Type | Organization
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Legal Business Name | WELLNESS FOOT AND ANKLE SURGERY CLINIC INC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 9310 VALLEY BLVD SUITE A
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City | ROSEMEAD
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State | CA
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Zip | 91770-1924
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Country | US
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Telephone | 626-288-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 9310 VALLEY BLVD SUITE A
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City | ROSEMEAD
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State | CA
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Zip | 91770-1924
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Country | US
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Telephone | 626-288-8671
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DERRICK CHEUNG LEW
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Credential | D.P.M
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Telephone | 626-288-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5066
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License Number State | CA
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