Healthcare Provider Details

I. General information

NPI: 1346212685
Provider Name (Legal Business Name): JASON WONG MD, MPH, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FLEETWOOD RD UNIT 315
MC LEAN VA
22101-3690
US

IV. Provider business mailing address

PO BOX 20007
NEW YORK NY
10023-1482
US

V. Phone/Fax

Practice location:
  • Phone: 917-751-0823
  • Fax:
Mailing address:
  • Phone: 917-751-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number334120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: