Provider Demographics
NPI:1275841066
Name:WONG, EILEEN HAI HUAT (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:HAI HUAT
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5224
Mailing Address - Country:US
Mailing Address - Phone:330-422-7734
Mailing Address - Fax:330-422-7738
Practice Address - Street 1:9318 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5224
Practice Address - Country:US
Practice Address - Phone:330-422-7734
Practice Address - Fax:330-422-7738
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136912207RS0012X
IL125057344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201083450AMedicaid