Healthcare Provider Details

I. General information

NPI: 1376925958
Provider Name (Legal Business Name): YU-TING WUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 8TH ST S
MOORHEAD MN
56560-3604
US

IV. Provider business mailing address

1919 ELM ST N
FARGO ND
58102-2416
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3100
  • Fax:
Mailing address:
  • Phone: 701-293-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number64990
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: