Healthcare Provider Details

I. General information

NPI: 1760421473
Provider Name (Legal Business Name): EDWARD SANG WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 EDWARD HOLLAND DRIVE
RICHMOND VA
23230-2519
US

IV. Provider business mailing address

4299 SAN FELIPE SUITE 300
HOUSTON TX
77027-2916
US

V. Phone/Fax

Practice location:
  • Phone: 804-678-7091
  • Fax: 804-204-1724
Mailing address:
  • Phone: 832-476-3900
  • Fax: 832-476-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101036283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: