Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE00010168 | WA |
NPI | 1003970450 |
---|---|
Provider Name | Dr. Kanton Ming Wong |
First Address | Bellevue, WA 98006-5626 |
Second Address | Seattle, WA 98125-6156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 18/01/2008 |