Provider Demographics
NPI:1003321514
Name:WONG, KIT LING (DDS)
Entity Type:Individual
Prefix:
First Name:KIT LING
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16015 STATION RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4115
Mailing Address - Country:US
Mailing Address - Phone:646-919-4897
Mailing Address - Fax:
Practice Address - Street 1:99 PROSPECT ST # 1C
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1636
Practice Address - Country:US
Practice Address - Phone:203-504-2786
Practice Address - Fax:203-504-2786
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist