Provider Demographics
NPI:1467746339
Name:WY, PAULETTE ANN WONG (MD)
Entity Type:Individual
Prefix:
First Name:PAULETTE ANN
Middle Name:WONG
Last Name:WY
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 1:4426 KETCHAM ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3649
Mailing Address - Country:US
Mailing Address - Phone:347-421-4264
Mailing Address - Fax:
Practice Address - Street 1:1301 WOLFE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5320
Practice Address - Country:US
Practice Address - Phone:501-364-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1158772080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics