Provider Demographics
NPI:1316389430
Name:WEI KONG CHANG ESTATE
Entity Type:Organization
Organization Name:WEI KONG CHANG ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-578-3321
Mailing Address - Street 1:1004 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-1618
Mailing Address - Country:US
Mailing Address - Phone:563-578-3321
Mailing Address - Fax:563-578-3322
Practice Address - Street 1:1004 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1618
Practice Address - Country:US
Practice Address - Phone:563-578-3321
Practice Address - Fax:563-578-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty