Healthcare Provider Details

I. General information

NPI: 1366374316
Provider Name (Legal Business Name): JEFFREY WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 S ROUTE 59
NAPERVILLE IL
60564-8148
US

IV. Provider business mailing address

1034 SAVOY CT
ELK GROVE VILLAGE IL
60007-3484
US

V. Phone/Fax

Practice location:
  • Phone: 630-416-1151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209034332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: