Healthcare Provider Details

I. General information

NPI: 1881511996
Provider Name (Legal Business Name): WEI CHANG YAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DINGENS ST
BUFFALO NY
14206-2319
US

IV. Provider business mailing address

39 LASALLE AVE APT 420
BUFFALO NY
14214-1453
US

V. Phone/Fax

Practice location:
  • Phone: 917-376-3341
  • Fax:
Mailing address:
  • Phone: 917-376-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1047811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: