Healthcare Provider Details

I. General information

NPI: 1750955696
Provider Name (Legal Business Name): YUNG SHU WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH, APO, AE 09461
BRANDON SUFFOLK
IP27 9PN
GB

IV. Provider business mailing address

48TH MDG/RAF LAKENHEATH, APO AE 09461
BRANDON SUFFOLK
IP27 9PN
GB

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.47015
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: