=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134594708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASSION CARE DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2015
-----------------------------------------------------
Last Update Date | 12/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2727 HAMBURG ST STE 3
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12303-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-992-1329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 HAMBURG ST
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12303-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-387-9896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KAI L WONG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 518-387-9896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 50139
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------