Healthcare Provider Details

I. General information

NPI: 1558314641
Provider Name (Legal Business Name): QUE-CHI VUONG WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QUE-CHI VUONG TRAN M.D.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CHEWS LANDING RD SUITE 14
LAUREL SPRINGS NJ
08021-2769
US

IV. Provider business mailing address

3322 AVALON CT
VOORHEES NJ
08043-4642
US

V. Phone/Fax

Practice location:
  • Phone: 856-227-6575
  • Fax:
Mailing address:
  • Phone: 856-810-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA08031300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: