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General NPI Number Information
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NPI Number | 1881843142
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Entity Type | Individual
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Provider Name | JENNY SUH WONG
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 6550 FANNIN ST SUITE 1401
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City | HOUSTON
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State | TX
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Zip | 77030-2717
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Country | US
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Telephone | 713-441-5200
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Fax | 713-793-7428
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Provider Business Mailing Address
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Address Line | 6550 FANNIN ST SUITE 1401
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City | HOUSTON
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State | TX
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Zip | 77030-2717
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Country | US
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Telephone | 713-441-5200
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Fax | 713-793-7428
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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 | 002122
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 013473-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA08414
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08414
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License Number State | TX
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