MEDICARE: KIN WONG, D.O., PA

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	261QU0200X	Urgent Care Clinic/Center	K9458	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972771319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIN WONG, D.O., PA

Provider Business Mailing Address
First Line	:	2327 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2904
Country	:	US
Telephone Number	:	817-834-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2904
Country	:	US
Telephone Number	:	817-834-1655
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. KIN SING WONG
Credential	:	D.O.
Telephone Number	:	817-834-1655

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	09/05/2008

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Directions to “KIN WONG, D.O., PA ” Practice Location

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