Healthcare Provider Details

I. General information

NPI: 1710890751
Provider Name (Legal Business Name): EMILY MARGARET WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 SISTERS GRV STE 110
COLORADO SPRINGS CO
80923-2628
US

IV. Provider business mailing address

7435 SISTERS GRV STE 110
COLORADO SPRINGS CO
80923-2628
US

V. Phone/Fax

Practice location:
  • Phone: 719-960-0363
  • Fax:
Mailing address:
  • Phone: 719-960-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC-APN.0107469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: