Healthcare Provider Details

I. General information

NPI: 1023129426
Provider Name (Legal Business Name): WAI SHUN WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MERCY HEALTH BLVD STE 125
CINCINNATI OH
45211
US

IV. Provider business mailing address

3301 MERCY HEALTH BLVD STE 125
CINCINNATI OH
45211-1106
US

V. Phone/Fax

Practice location:
  • Phone: 513-215-9200
  • Fax: 513-215-9259
Mailing address:
  • Phone: 513-215-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301090894
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301090894
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00043721
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301090894
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35134077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: