Healthcare Provider Details

I. General information

NPI: 1952379588
Provider Name (Legal Business Name): JACKSON WONG-SICK-HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 W OKMULGEE ST
MUSKOGEE OK
74401-5069
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-687-6002
  • Fax: 918-687-6216
Mailing address:
  • Phone: 918-488-6653
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18881
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: