Provider Demographics
NPI:1407982259
Name:WONG, KIM KIT YENG (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:KIT YENG
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 THEODORE FREMD AVE
Mailing Address - Street 2:#B8
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 THEODORE FREMD AVE
Practice Address - Street 2:#B8
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2872
Practice Address - Country:US
Practice Address - Phone:303-885-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251591207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology