Healthcare Provider Details

I. General information

NPI: 1558650200
Provider Name (Legal Business Name): MINNA MINSING CHEN WIECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINNA MINSING CHEN MD

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD., ROOM 517
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

2315 STOCKTON BLVD., DEPARTMENT OF SURGERY
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2080
  • Fax: 916-453-2035
Mailing address:
  • Phone: 916-453-2080
  • Fax: 916-453-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA130197
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036145539
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA130197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: