Healthcare Provider Details

I. General information

NPI: 1629659107
Provider Name (Legal Business Name): TIFFANY HAU YEN WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

VCUHS GMEA BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9331
  • Fax: 804-806-7587
Mailing address:
  • Phone: 804-828-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0116037071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: