Healthcare Provider Details

I. General information

NPI: 1497193965
Provider Name (Legal Business Name): CHRISTINA WONG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 NW MARKET ST
SEATTLE WA
98107-3743
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5584
  • Fax: 206-720-7428
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOP60746844
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: