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General NPI Number Information
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NPI Number | 1801890314
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Entity Type | Individual
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Provider Name | CHARLES CHU-LI WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1729 KINNEYS LANE SUITE 203
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3167
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Country | US
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Telephone | 740-354-2942
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Fax | 740-353-3661
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Provider Business Mailing Address
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Address Line | 1729 KINNEYS LANE SUITE 203
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3167
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Country | US
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Telephone | 740-354-2942
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Fax | 704-353-3661
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 63264
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35063264W
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License Number State | OH
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