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General NPI Number Information
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NPI Number | 1205787470
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Entity Type | Individual
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Provider Name | KINMING LAWRENCE WONG
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Gender | Male
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 24042 67TH AVE # 1F
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City | DOUGLASTON
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State | NY
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Zip | 11362-1927
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Country | US
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Telephone | 646-588-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 24042 67TH AVE # 1F
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City | DOUGLASTON
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State | NY
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Zip | 11362-1927
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Country | US
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Telephone | 646-588-9994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 961293
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License Number State | NY
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