Healthcare Provider Details

I. General information

NPI: 1932320538
Provider Name (Legal Business Name): WILLIAM K WONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 KENILWORTH AVENUE SUITE 1200
RIVERDALE MD
20737
US

IV. Provider business mailing address

21616 76TH AVE SUITE #102
EDMONDS WA
98026
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-2933
  • Fax: 301-927-9406
Mailing address:
  • Phone: 425-774-1538
  • Fax: 301-927-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034525
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS01955
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: