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NPI Code Detail

MEDICARE: KA C WONG MD PA

MEDICARE: KA C WONG MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0011XInterventional Cardiology PhysicianG2887TX

General Provider Information

NPI Number : 1619194131
Entity Type Code : Organization
Provider Name (Legal Business Name) : KA C WONG MD PA
Provider Business Mailing Address
First Line : 3270 JOE BATTLE BLVD
Second Line : SUITE 380
City : EL PASO
State : TX
Zip : 79938-2622
Country : US
Telephone Number : 915-592-8013
Fax Number :
Provider Business Practice Location Address
First Line : 3270 JOE BATTLE BLVD
Second Line : SUITE 380
City : EL PASO
State : TX
Zip : 79938-2622
Country : US
Telephone Number : 915-592-8013
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. KA CHUN WONG
Credential : M.D.
Telephone Number : 915-592-8013
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/24/2009

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