Provider Demographics
NPI:1043857220
Name:VIVO DERMATOLOGY AND SKIN SURGERY
Entity type:Organization
Organization Name:VIVO DERMATOLOGY AND SKIN SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WEI-WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-2095
Mailing Address - Street 1:621 S NEW BALLAS RD STE 597A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8262
Mailing Address - Country:US
Mailing Address - Phone:314-251-2095
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 597A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8262
Practice Address - Country:US
Practice Address - Phone:314-251-2095
Practice Address - Fax:314-251-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861602757Medicaid