Provider Demographics
NPI:1326178740
Name:WONG, GUONTUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:GUONTUNG
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:515 S MOORE STREET
Mailing Address - Street 2:UNITED HOSPITAL DISTRICT
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:267-251-3385
Mailing Address - Fax:
Practice Address - Street 1:515 S MOORE STREET
Practice Address - Street 2:UNITED HOSPITAL DISTRICT
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013
Practice Address - Country:US
Practice Address - Phone:267-251-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51018208600000X
CAA99052208600000X
NV14090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFN767ZMedicare UPIN