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General NPI Number Information
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NPI Number | 1821022807
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Entity Type | Organization
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Legal Business Name | YU HO WONG, M.D, P.A
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 557 HEALTH BLVD SUITE 102
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-252-0501
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Fax | 386-254-0652
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Provider Business Mailing Address
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Address Line | 557 HEALTH BLVD SUITE 102
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-252-0501
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Fax | 386-254-0652
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YU HO WONG
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Credential | MD
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Telephone | 386-252-0501
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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 | ME-68825
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License Number State | FL
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