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General NPI Number Information
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NPI Number | 1780038612
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Entity Type | Individual
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Provider Name | BRIAN S WONG WON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 399 FARMINGTON AVE STE 210
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City | FARMINGTON
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State | CT
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Zip | 06032-1944
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Country | US
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Telephone | 860-548-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-3955
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Country | US
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Telephone | 860-679-3467
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Fax | 860-679-1460
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | V0227
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 81425
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License Number State | CT
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