Healthcare Provider Details

I. General information

NPI: 1356468839
Provider Name (Legal Business Name): HARRY Y. WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 WILCREST DR STE A
HOUSTON TX
77072-4326
US

IV. Provider business mailing address

8300 WILCREST DR STE A
HOUSTON TX
77072-4326
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 832-460-7736
Mailing address:
  • Phone: 134-612-9157
  • Fax: 832-460-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK5748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: