Healthcare Provider Details

I. General information

NPI: 1043846512
Provider Name (Legal Business Name): DR. ALAN WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WESTCHESTER HALL STONY BROOK UNIVERSITY HOSPITAL SCHOOL OF DENTAL MEDICI
STONY BROOK NY
11794-8711
US

IV. Provider business mailing address

2531 TURNER ST
VANCOUVER BC
V5D2E9
CA

V. Phone/Fax

Practice location:
  • Phone: 631-444-2557
  • Fax: 631-444-6013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: