MEDICARE: KIM WONG RPH

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	183500000X	Pharmacist	048239	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124046065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM WONG RPH

Provider Business Mailing Address
First Line	:	19 E DOSORIS LN
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6402
Country	:	US
Telephone Number	:	631-242-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	8319 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7320
Country	:	US
Telephone Number	:	718-424-1101
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/01/2013

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