MEDICARE: KAREN HOIWAN WONG-LI RD, 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
1	133V00000X	Registered Dietitian	TPND1336	FL
2	133V00000X	Registered Dietitian	DT07208	TX
3	133V00000X	Registered Dietitian	5466	TN

General Provider Information

NPI Number	:	1255673497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN HOIWAN WONG-LI RD, LD

Provider Business Mailing Address
First Line	:	PO BOX 649
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-0649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CORNER OF ROUTE N12 & N7
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-0649
Country	:	US
Telephone Number	:	928-729-8000
Fax Number	:

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

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2026

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