Provider Demographics
NPI:1285799668
Name:WENG, EDWARD E (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:WENG
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 1:315 MLK JR WAY
Mailing Address - Street 2:MS: 315-J1-TRM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-403-7537
Mailing Address - Fax:253-403-4576
Practice Address - Street 1:315 MLK JR WAY
Practice Address - Street 2:MS: 315-J1-TRM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-403-7537
Practice Address - Fax:253-403-4576
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045288208600000X
WAMD60101109208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003811Medicaid
MI4109780Medicaid
MI4109780Medicaid