Provider Demographics
NPI:1558314641
Name:WONG, QUE-CHI VUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:QUE-CHI
Middle Name:VUONG
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QUE-CHI
Other - Middle Name:VUONG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3322 AVALON CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4642
Mailing Address - Country:US
Mailing Address - Phone:856-810-0474
Mailing Address - Fax:
Practice Address - Street 1:1405 CHEWS LANDING RD
Practice Address - Street 2:SUITE 14
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2769
Practice Address - Country:US
Practice Address - Phone:856-227-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08031300207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02566296Medicaid
NY02566296Medicaid
NYI11275Medicare UPIN