Healthcare Provider Details

I. General information

NPI: 1053954891
Provider Name (Legal Business Name): KAYIN WONG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

14553 SW 153RD CT
MIAMI FL
33196-2813
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6856
  • Fax:
Mailing address:
  • Phone: 786-623-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004740
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11004740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: