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General NPI Number Information
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NPI Number | 1508817214
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Entity Type | Individual
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Provider Name | ALLEN WONG MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 323 E RIVERSIDE DR STE 224
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City | EAGLE
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State | ID
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Zip | 83616-6865
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Country | US
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Telephone | 208-302-6000
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Fax | 208-302-6055
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Provider Business Mailing Address
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Address Line | 500 W FORT ST ORANGE
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City | BOISE
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State | ID
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Zip | 83702-4501
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Country | US
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Telephone | 208-422-1326
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9700162
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M-17388
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License Number State | ID
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