Provider Demographics
NPI:1598933475
Name:WONG, LISA JUN-PEI (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JUN-PEI
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 FOSSIL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6149
Mailing Address - Country:US
Mailing Address - Phone:720-466-3937
Mailing Address - Fax:
Practice Address - Street 1:2308 FOSSIL TRACE DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6149
Practice Address - Country:US
Practice Address - Phone:720-466-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49920207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62922041Medicaid
CO029307OtherKAISER COMMERCAIL NUMBER