Provider Demographics
NPI:1225019342
Name:WONG, WAICHI (MD)
Entity Type:Individual
Prefix:DR
First Name:WAICHI
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS. GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST GRB 1003
Practice Address - Street 2:RENAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-5277
Practice Address - Fax:617-724-8652
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA161332207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2073480Medicaid
MA469401OtherTUFTS HEALTH PLAN
MAJ27756OtherBCBS OF MA
MAJ27756OtherBCBS OF MA
MAA37407Medicare ID - Type Unspecified