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Organization
MOGENS U WIESE MD INC
Active
Organization
MOGENS U WIESE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOGENS U. WIESE M.D. (OWNER)
(310) 471-5852
Entity
Organization
Contact information
Practice address
215 W JANSS RD, THOUSAND OAKS, CA 91360-1847
(310) 471-5852
(310) 471-3958
Mailing address
1633 ERRINGER RD, 1ST FLOOR, SIMI VALLEY, CA 93065-3583
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A37380
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0052480
—
CA
05
—
GR0052481
—
CA
Enumeration date
08/03/2006
Last updated
11/16/2009
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