Healthcare Provider Details

I. General information

NPI: 1861955817
Provider Name (Legal Business Name): WEI-KANG CHANG CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SUGAR CREEK CENTER BLVD STE 510
SUGAR LAND TX
77478-3673
US

IV. Provider business mailing address

77 SUGAR CREEK CENTER BLVD STE 510
SUGAR LAND TX
77478-3673
US

V. Phone/Fax

Practice location:
  • Phone: 281-495-5966
  • Fax:
Mailing address:
  • Phone: 281-495-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number7298
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number7298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: