Provider Demographics
NPI:1326024761
Name:WONG, EDWARD WAI (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WAI
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1242
Mailing Address - Fax:
Practice Address - Street 1:FLAT K, 34TH FLOOR, BLOCK 7
Practice Address - Street 2:HARBOUR PLACE, HUNGHOM, KOWLOON
Practice Address - City:HONG KONG
Practice Address - State:NOT APPLICABLE
Practice Address - Zip Code:NOT APPLICABLE
Practice Address - Country:CN
Practice Address - Phone:952-595-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO421702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology