Healthcare Provider Details

I. General information

NPI: 1851201065
Provider Name (Legal Business Name): CHRISTINE WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE YOUNG MD

II. Dates (important events)

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

III. Provider practice location address

3292 BAYVIEW AVE SUITE 105
TORONTO ONTARIO
M4M 4J5
CA

IV. Provider business mailing address

3020 COMPASS POINTE WALK
ALPHARETTA GA
30005-8850
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114453
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: