Healthcare Provider Details

I. General information

NPI: 1760468029
Provider Name (Legal Business Name): ALLERGY & ASTHMA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HAWTHORNE PL SUITE 104
BOSTON MA
02114-2335
US

IV. Provider business mailing address

8 HAWTHORNE PL SUITE 104
BOSTON MA
02114-2335
US

V. Phone/Fax

Practice location:
  • Phone: 617-742-5730
  • Fax: 617-742-6917
Mailing address:
  • Phone: 617-742-5730
  • Fax: 617-742-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number53165
License Number StateMA

VIII. Authorized Official

Name: DR. JOHNSON TAI WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-742-5730