Provider Demographics
NPI:1093810319
Name:WONG, PO HING (MD)
Entity Type:Individual
Prefix:DR
First Name:PO
Middle Name:HING
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-285-6349
Mailing Address - Fax:972-289-6717
Practice Address - Street 1:200 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-285-6349
Practice Address - Fax:972-289-6717
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23721Medicare UPIN
00HB52Medicare ID - Type Unspecified