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General NPI Number Information
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NPI Number | 1851720239
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Entity Type | Individual
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Provider Name | YUEN LING WONG KONG P.A-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 3460 OLD WASHINGTON RD SUITE 203A
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City | WALDORF
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State | MD
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Zip | 20602-3240
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Country | US
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Telephone | 301-638-0602
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Fax | 301-638-7558
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Provider Business Mailing Address
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Address Line | 3460 OLD WASHINGTON RD SUITE 203A
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City | WALDORF
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State | MD
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Zip | 20602-3240
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Country | US
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Telephone | 301-638-0602
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Fax | 301-638-7558
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-004388
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License Number State | VA
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