Basic Information
| Provider Information | |||||||||
| NPI: | 1285799668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WENG | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 MLK JR WAY | ||||||||
| Address2: | MS: 315-J1-TRM | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037537 | ||||||||
| FaxNumber: | 2534034576 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 MLK JR WAY | ||||||||
| Address2: | MS: 315-J1-TRM | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534037537 | ||||||||
| FaxNumber: | 2534034576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301045288 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD60101109 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4109780 | 05 | MI | MEDICAID |