Healthcare Provider Details

I. General information

NPI: 1528074705
Provider Name (Legal Business Name): WAN CHONG TSAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WAN CHUEN CHONG

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD SUITE 405
EAST LANSING MI
48823-5376
US

IV. Provider business mailing address

804 SERVICE RD # A201
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-8600
  • Fax: 517-884-8650
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301062502
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4301062502
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35096852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: