MEDICARE: KIN WONG

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0038NJ	OTHER	TX	BC/BS OF TEXAS

General Provider Information

NPI Number	:	1114943362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIN WONG

Provider Business Mailing Address
First Line	:	1221 N COTTON ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-3015
Country	:	US
Telephone Number	:	915-496-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 N COTTON ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-3015
Country	:	US
Telephone Number	:	915-496-9600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIN SING WONG
Credential	:	DO
Telephone Number	:	915-496-9600

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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Directions to “KIN WONG ” Practice Location

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