Provider Demographics
NPI:1598979759
Name:WONG, KHANHMEI L (DPM)
Entity Type:Individual
Prefix:DR
First Name:KHANHMEI
Middle Name:L
Last Name:WONG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4272
Mailing Address - Country:US
Mailing Address - Phone:413-584-2171
Mailing Address - Fax:413-584-2792
Practice Address - Street 1:22 ATWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4272
Practice Address - Country:US
Practice Address - Phone:413-584-2171
Practice Address - Fax:413-584-2792
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2310213ES0131X
WAPO00000827213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000372602Medicare PIN