Provider Demographics
NPI:1487672929
Name:CHUNG, WEN-WEI (MD)
Entity Type:Individual
Prefix:
First Name:WEN-WEI
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1875 WOODWINDS DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2298
Mailing Address - Country:US
Mailing Address - Phone:651-264-1500
Mailing Address - Fax:651-264-1646
Practice Address - Street 1:1875 WOODWINDS DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-264-1500
Practice Address - Fax:651-264-1646
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN45196207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN522496900Medicaid
MN191813300Medicaid
MN099565700Medicaid