Healthcare Provider Details

I. General information

NPI: 1184821647
Provider Name (Legal Business Name): LINCOLN MANFEI WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

9902 HARNEY PKWY N
OMAHA NE
68114-4947
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5400
  • Fax:
Mailing address:
  • Phone: 402-212-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number25175
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25175
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: