Provider Demographics
NPI:1669043139
Name:WONG, CHUN WING (MBBS)
Entity type:Individual
Prefix:
First Name:CHUN WING
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 DEXTER AVE N APT W223
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3561
Mailing Address - Country:US
Mailing Address - Phone:206-601-1059
Mailing Address - Fax:
Practice Address - Street 1:1414 DEXTER AVE N APT W223
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3561
Practice Address - Country:US
Practice Address - Phone:206-601-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10074491390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program