Healthcare Provider Details

I. General information

NPI: 1164568085
Provider Name (Legal Business Name): PETER KUO-YEN WUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 450
HOUSTON TX
77030
US

IV. Provider business mailing address

6410 FANNIN ST STE 450
HOUSTON TX
77030-3008
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-3100
  • Fax: 713-512-2246
Mailing address:
  • Phone: 713-486-3100
  • Fax: 713-512-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberP8205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: