MEDICARE: DR. WAI CHONG WONG M.D.-PH.D.

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
1	207N00000X	Dermatology Physician	146288	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730507435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAI CHONG WONG M.D.-PH.D.

Provider Business Mailing Address
First Line	:	8625 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-3550
Country	:	US
Telephone Number	:	239-732-0044
Fax Number	:	239-732-0094

Provider Business Practice Location Address
First Line	:	8625 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-3550
Country	:	US
Telephone Number	:	239-732-0044
Fax Number	:	239-732-0094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	07/27/2020

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