Provider Demographics
NPI:1407172521
Name:WONG, ANDREW WAE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAE
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 1:4402 VANCE JACKSON RD STE 146
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5333
Mailing Address - Country:US
Mailing Address - Phone:210-962-5557
Mailing Address - Fax:210-962-5558
Practice Address - Street 1:4402 VANCE JACKSON RD STE 146
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5333
Practice Address - Country:US
Practice Address - Phone:210-962-5557
Practice Address - Fax:210-962-5558
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD512752084N0400X
VA01012581632084N0400X
TXR36192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407172521Medicaid
VAVVH976AMedicare PIN
VAP01514843Medicare PIN