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1558867465 NPI number — ANDREW K WONG MD

NPI Number: 1558867465
Health Care Provider/Practitioner: ANDREW K WONG MD

Information about “1558867465” NPI (ANDREW K WONG MD) exists in 1558867465 in HTML format HTML  |  1558867465 in plain Text format TXT  |  1558867465 in PDF (Portable Document Format) PDF  |  1558867465 in an XML format XML  formats.

NPI Number : 1558867465 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558867465",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WONG",
    "FirstName": "ANDREW",
    "MiddleName": "K",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1301 S CAPITAL OF TEXAS HWY STE 128B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST LAKE HILLS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78746-6586",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-200-3087",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1301 S CAPITAL OF TEXAS HWY STE 128B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST LAKE HILLS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78746-6586",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-200-3087",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/01/2018",
    "LastUpdateDate": "07/18/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "T4290",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2084P0804X",
          "TaxonomyName": "Child & Adolescent Psychiatry Physician",
          "LicenseNumber": "4301509426",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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