Healthcare Provider Details

I. General information

NPI: 1033848767
Provider Name (Legal Business Name): ALFREDO WONG JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DRIVE HERSHEL 'WOODY' WILLIAMS VAMC
HUNTINGTON WV
25704
US

IV. Provider business mailing address

1540 SPRING VALLEY DRIVE HERSHEL 'WOODY' WILLIAMS VAMC
HUNTINGTON WV
25704
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax: 304-429-0262
Mailing address:
  • Phone: 304-429-6741
  • Fax: 304-429-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4671
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: