Provider Demographics
NPI:1619194131
Name:KA C WONG MD PA
Entity Type:Organization
Organization Name:KA C WONG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KA
Authorized Official - Middle Name:CHUN
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-592-8013
Mailing Address - Street 1:3270 JOE BATTLE BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2622
Mailing Address - Country:US
Mailing Address - Phone:915-592-8013
Mailing Address - Fax:
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2622
Practice Address - Country:US
Practice Address - Phone:915-592-8013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2887207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U02ZMedicare PIN