Provider Demographics
NPI:1164618336
Name:WONG, DAVID (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 TAFT BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4800
Mailing Address - Country:US
Mailing Address - Phone:940-692-5666
Mailing Address - Fax:940-767-3578
Practice Address - Street 1:4722 TAFT BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4800
Practice Address - Country:US
Practice Address - Phone:940-692-5666
Practice Address - Fax:940-767-3578
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M8426OtherBLUE CROSS BLUE SHIELD