Healthcare Provider Details

I. General information

NPI: 1598979759
Provider Name (Legal Business Name): KHANHMEI L. WONG D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S HWY 27 STE 205F
CLERMONT FL
34711-8067
US

IV. Provider business mailing address

6433 QUARTET ST
MASCOTTE FL
34753-9319
US

V. Phone/Fax

Practice location:
  • Phone: 352-809-8709
  • Fax:
Mailing address:
  • Phone: 413-387-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4728
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000827
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: