Provider Demographics
NPI:1417358003
Name:WONG, ALAN CHUNGYI (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CHUNGYI
Last Name:WONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:909 W SPRING CREEK PKWY STE 490
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4477
Mailing Address - Country:US
Mailing Address - Phone:972-905-1287
Mailing Address - Fax:
Practice Address - Street 1:909 W SPRING CREEK PKWY STE 490
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4477
Practice Address - Country:US
Practice Address - Phone:972-905-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0586671223G0001X
CA640601223G0001X
TX339621223G0001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice