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General NPI Number Information
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NPI Number | 1316268477
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Entity Type | Individual
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Provider Name | MELISSA WONG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1400 E KINCAID ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4127
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Country | US
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Telephone | 360-428-2586
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Fax | 360-428-6470
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Provider Business Mailing Address
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Address Line | 1400 E KINCAID ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4127
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Country | US
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Telephone |
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Fax | 414-955-6222
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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 | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 67538
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD61629411
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License Number State | WA
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