Healthcare Provider Details

I. General information

NPI: 1942297163
Provider Name (Legal Business Name): KERRY MARIE WONG FIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRY MARIE WONG MD

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 HILLSIDE AVE STE 303
NEEDHAM HEIGHTS MA
02494-1228
US

IV. Provider business mailing address

15747 105TH DR N
JUPITER FL
33478-6813
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-3588
  • Fax: 781-449-5474
Mailing address:
  • Phone: 315-296-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number113221
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: