Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD60281872 | WA |
NPI | 1003178567 |
---|---|
Provider Name | Kelvin Karl Yu Wong |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2012 |
Last Update Date | 10/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2022435 | (05) | WA |