Provider Demographics
NPI:1497846117
Name:WONG, SABRINA LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:LOUISE
Last Name:WONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MEDINA RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4514
Mailing Address - Country:US
Mailing Address - Phone:330-344-1255
Mailing Address - Fax:740-399-3891
Practice Address - Street 1:4125 MEDINA RD STE 200B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4514
Practice Address - Country:US
Practice Address - Phone:330-344-1255
Practice Address - Fax:740-399-3891
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006594D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018613Medicaid
OH300026245OtherUHC
OH340069404001OtherMEDICAL MUTUAL
OH000000213452OtherBLUE SHIELD
OH5240682OtherAETNA
OH300026245OtherUHC
G56616Medicare UPIN