Provider Demographics
NPI:1629005400
Name:WONG, KA C (MD)
Entity Type:Individual
Prefix:
First Name:KA
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:1250 E CLIFF DR STE 3D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4847
Practice Address - Country:US
Practice Address - Phone:915-857-4130
Practice Address - Fax:915-857-4135
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2887207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000V0906Medicaid
TXZ000U02Z0Medicaid
TX00HX97Medicare ID - Type Unspecified
NM0000V0906Medicaid