Provider Demographics
NPI:1013385541
Name:JAKE WONG DDS PC
Entity Type:Organization
Organization Name:JAKE WONG DDS PC
Other - Org Name:FIRSTCARE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-256-5858
Mailing Address - Street 1:8684 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3409
Mailing Address - Country:US
Mailing Address - Phone:718-256-5858
Mailing Address - Fax:646-357-1579
Practice Address - Street 1:8684 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3409
Practice Address - Country:US
Practice Address - Phone:718-256-5858
Practice Address - Fax:646-357-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty