Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401414447 | VA |
Y | 213EG0000X | General Practice | 0401414447 | VA |
NPI | 1003228636 |
---|---|
Provider Name | Dr. Joshua Wong |
First Address | Midlothian, VA 23113 |
Second Address | Chester, VA 23831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 26/08/2021 |