Healthcare Provider Details

I. General information

NPI: 1053223594
Provider Name (Legal Business Name): RICHARD TOMMY WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 JUNCTION BLVD APT 2W
JACKSON HEIGHTS NY
11372-2011
US

IV. Provider business mailing address

3324 JUNCTION BLVD APT 2W
JACKSON HEIGHTS NY
11372-2011
US

V. Phone/Fax

Practice location:
  • Phone: 305-420-6865
  • Fax:
Mailing address:
  • Phone: 305-420-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: