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NPI Code Detail

MEDICARE: KAM WONG LD

MEDICARE: KAM WONG LD
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
1122400000XDenturist25108DN32WA

General Provider Information

NPI Number : 1205080009
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAM WONG LD
Provider Business Mailing Address
First Line : 4501 44TH AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4116
Country : US
Telephone Number : 206-935-6844
Fax Number : 206-935-6844
Provider Business Practice Location Address
First Line : 4501 44TH AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4116
Country : US
Telephone Number : 206-935-6844
Fax Number : 206-935-6844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2008
Last Update Date : 11/06/2008

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Directions to “ KAM WONG LD” Practice Location

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