MEDICARE: DR. JACKSON WONG-SICK-HONG M.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	207RC0000X	Cardiovascular Disease Physician	18881	OK

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	:	1952379588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKSON WONG-SICK-HONG M.D.

Provider Business Mailing Address
First Line	:	6600 S YALE AVE STE 1400
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3331
Country	:	US
Telephone Number	:	918-488-6653
Fax Number	:	918-488-6098

Provider Business Practice Location Address
First Line	:	3340 W OKMULGEE ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-5069
Country	:	US
Telephone Number	:	918-687-6002
Fax Number	:	918-687-6216

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/13/2022

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Directions to “ DR. JACKSON WONG-SICK-HONG M.D.” Practice Location

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