Healthcare Provider Details

I. General information

NPI: 1235192576
Provider Name (Legal Business Name): KWOK KIN WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE MAYER BUILDING 413
BOSTON MA
02215-5418
US

IV. Provider business mailing address

450 BROOKLINE AVE MAYER BUILDING 413
BOSTON MA
02215-5418
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6084
  • Fax: 617-582-7839
Mailing address:
  • Phone: 617-632-6084
  • Fax: 617-582-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number157104
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: