MEDICARE: DR. KENNETH WONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	D0075637	MD

General Provider Information

NPI Number	:	1073775433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WONG M.D.

Provider Business Mailing Address
First Line	:	6201 GREENBELT RD STE M11
Second Line	:
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2333
Country	:	US
Telephone Number	:	301-441-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 GREENBELT RD STE M11
Second Line	:
City	:	BERWYN HEIGHTS
State	:	MD
Zip	:	20740-2333
Country	:	US
Telephone Number	:	301-441-9330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	03/02/2022

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