Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D0075637 | MD |
NPI | 1073775433 |
---|---|
Provider Name | Dr. Kenneth Wong |
First Address | Washington, DC 20002-4301 |
Second Address | Berwyn Heights, MD 20740-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 15/01/2020 |