Provider Demographics
NPI:1558650200
Name:WIECK, MINNA MINSING CHEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MINNA
Middle Name:MINSING CHEN
Last Name:WIECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINNA
Other - Middle Name:MINSING
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2315 STOCKTON BLVD., DEPARTMENT OF SURGERY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-453-2080
Mailing Address - Fax:916-453-2035
Practice Address - Street 1:2425 STOCKTON BLVD., ROOM 517
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2215
Practice Address - Country:US
Practice Address - Phone:916-453-2080
Practice Address - Fax:916-453-2035
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA130197208600000X, 2086S0120X
OR390200000X
IL036145539390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery