Healthcare Provider Details

I. General information

NPI: 1780038612
Provider Name (Legal Business Name): BRIAN S WONG WON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE STE 210
FARMINGTON CT
06032-1944
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-3955
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-7338
  • Fax:
Mailing address:
  • Phone: 860-679-3467
  • Fax: 860-679-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberV0227
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number81425
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: