Healthcare Provider Details

I. General information

NPI: 1073640462
Provider Name (Legal Business Name): WAH JEW KONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 CLINTON DR
GALENA PARK TX
77547
US

IV. Provider business mailing address

PO BOX 404 2205 CLINTON DR
GALENA PARK TX
77547
US

V. Phone/Fax

Practice location:
  • Phone: 713-674-0550
  • Fax:
Mailing address:
  • Phone: 713-674-0550
  • Fax: 713-674-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: