Provider Demographics
NPI:1548411457
Name:WONG, SIMON CHI-HIN (DO, MBA, MM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:CHI-HIN
Last Name:WONG
Suffix:
Gender:M
Credentials:DO, MBA, MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 NW 33RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4081
Mailing Address - Country:US
Mailing Address - Phone:954-603-5508
Mailing Address - Fax:954-603-1038
Practice Address - Street 1:9750 NW 33RD ST STE 210
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4081
Practice Address - Country:US
Practice Address - Phone:954-603-5508
Practice Address - Fax:954-603-1038
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN562AMedicare PIN