MEDICARE: MR. PETER KAM-HO WONG M.S.

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	106H00000X	Marriage & Family Therapist	RC00050778	WA

General Provider Information

NPI Number	:	1679766323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER KAM-HO WONG M.S.

Provider Business Mailing Address
First Line	:	3415 80TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3522
Country	:	US
Telephone Number	:	206-230-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 116TH AVE NE
Second Line	:	SUITE 3
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3047
Country	:	US
Telephone Number	:	206-356-3233
Fax Number	:

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

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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