Healthcare Provider Details

I. General information

NPI: 1134860216
Provider Name (Legal Business Name): JANINE WONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27155 CHARDON RD STE 201
RICHMOND HEIGHTS OH
44143-1166
US

IV. Provider business mailing address

1900 FRONTAGE RD APT 1002
CHERRY HILL NJ
08034-2215
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-6553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.017994
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number34.017994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: