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NPI Code Detail

MEDICARE: DR. CHARLES MEN WONG MD

MEDICARE: DR. CHARLES MEN 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
1208D00000XGeneral Practice PhysicianMD14849OR

General Provider Information

NPI Number : 1659394187
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES MEN WONG MD
Provider Business Mailing Address
First Line : 4160 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97212-5336
Country : US
Telephone Number : 503-249-9000
Fax Number : 503-719-6823
Provider Business Practice Location Address
First Line : 2850 SE POWELL VALLEY RD
Second Line :
City : GRESHAM
State : OR
Zip : 97080-1494
Country : US
Telephone Number : 503-666-5050
Fax Number : 503-666-7410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 11/03/2016

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