Provider Demographics
NPI:1306813852
Name:WONG, LESLEY (MD)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE KY CLINIC K454
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY - DIVISION OF PLASTIC SURGERY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-1293
Mailing Address - Fax:859-323-3823
Practice Address - Street 1:740 S LIMESTONE KY CLINIC K454
Practice Address - Street 2:UNIVERSITY OF KENTUCKY - DIVISION OF PLASTIC SURGERY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-1293
Practice Address - Fax:859-323-3823
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY426102086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3852916Medicare PIN
D72192Medicare UPIN