Provider Demographics
NPI:1235192576
Name:WONG, KWOK KIN (MD)
Entity Type:Individual
Prefix:
First Name:KWOK KIN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:MAYER BUILDING 413
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-6084
Mailing Address - Fax:617-582-7839
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:MAYER BUILDING 413
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-6084
Practice Address - Fax:617-582-7839
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157104207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
65587OtherFALLON COMMUNITY HLTH PLN
157104OtherTUFTS
0170348OtherMASSHEALTH MA MEDICAID
14721DFOtherHPHC DFCI
MAJ24871OtherBCBS INDEMNITY BC ELECT
3991845OtherCIGNA
2621393OtherAETNA US HEALTHCARE
3004733OtherUNITED HEALTH CARE
0170348OtherMASSHEALTH MA MEDICAID
3991845OtherCIGNA