Provider Demographics
NPI:1033203500
Name:WONG, JOANNE HAY-LING (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:HAY-LING
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 SW DELKER RD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7755
Mailing Address - Country:US
Mailing Address - Phone:503-638-2882
Mailing Address - Fax:
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 280
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1581
Practice Address - Country:US
Practice Address - Phone:503-418-5000
Practice Address - Fax:503-418-5007
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20847208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD660ORMedicaid
OR276660Medicaid
WA8227142Medicaid
OR108051Medicare ID - Type Unspecified
WA8227142Medicaid