Provider Demographics
NPI:1033234471
Name:WONG, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200428
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-0428
Mailing Address - Country:US
Mailing Address - Phone:303-320-5503
Mailing Address - Fax:
Practice Address - Street 1:6500 S QUEBEC ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-4671
Practice Address - Country:US
Practice Address - Phone:303-320-5503
Practice Address - Fax:303-220-9134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO381992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry