Provider Demographics
NPI:1588812440
Name:WONG, JAIME ALAN WAN CHEUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ALAN WAN CHEUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2594
Mailing Address - Country:US
Mailing Address - Phone:404-240-9700
Mailing Address - Fax:404-240-9701
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2594
Practice Address - Country:US
Practice Address - Phone:404-240-9700
Practice Address - Fax:404-240-9701
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003186208800000X
GA063232208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA063232OtherGEORGIA STATE LICENSE