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
State | License ID | Taxonomies |
---|---|---|
OH | 34006594D | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2018613 | Medicaid | |
OH | 300026245 | Other | UHC |
OH | 340069404001 | Other | MEDICAL MUTUAL |
OH | 000000213452 | Other | BLUE SHIELD |
OH | 5240682 | Other | AETNA |
OH | 300026245 | Other | UHC |
G56616 | Medicare UPIN |