Healthcare Provider Details

I. General information

NPI: 1447176870
Provider Name (Legal Business Name): EUGENE KAICHUNG WONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8159 S 4800 W
WEST JORDAN UT
84088-4703
US

IV. Provider business mailing address

3258 W JORDAN LINE PKWY APT 2-102
WEST JORDAN UT
84088-7948
US

V. Phone/Fax

Practice location:
  • Phone: 801-613-1816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14294675-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: