Healthcare Provider Details

I. General information

NPI: 1326144015
Provider Name (Legal Business Name): PHILIP KA-HING WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KA-HING WONG M.D.

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 51ST ST
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

8431 MCVICKER AVE
MORTON GROVE IL
60053-3232
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-2673
  • Fax: 312-945-4032
Mailing address:
  • Phone: 847-581-0916
  • Fax: 847-581-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036-064142
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-064142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: