Provider Demographics
NPI:1356653091
Name:WONG, KEN KOON (MD)
Entity Type:Individual
Prefix:
First Name:KEN KOON
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AKRON GENERAL AVE
Mailing Address - Street 2:5TH FLOOR, ACC BUILDING
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2432
Mailing Address - Country:US
Mailing Address - Phone:330-344-6015
Mailing Address - Fax:330-344-6820
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:5TH FLOOR, ACC BUILDING
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-6015
Practice Address - Fax:330-344-6820
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-125312207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH3600271OtherAKRON GENERAL MEDICARE GROUP #
OH0123634Medicaid
OH1821035940OtherAKRON GENERAL TYPE 2 NPI #
OH0454744OtherAKRON GENERAL (IMCA) MEDICAID GROUP #
OHH305770Medicare PIN