MEDICARE: ANDREW K WONG MD

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	2084P0800X	Psychiatry Physician	T4290	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	4301509426	MI

General Provider Information

NPI Number	:	1558867465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K WONG MD

Provider Business Mailing Address
First Line	:	1301 S CAPITAL OF TEXAS HWY STE 128B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6586
Country	:	US
Telephone Number	:	512-200-3087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 S CAPITAL OF TEXAS HWY STE 128B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6586
Country	:	US
Telephone Number	:	512-200-3087
Fax Number	:

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

Provider Enumeration Date	:	04/01/2018
Last Update Date	:	07/18/2023

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