Provider Demographics
NPI:1639471931
Name:WONG, NHAN GIA-CHAU (PA)
Entity Type:Individual
Prefix:
First Name:NHAN
Middle Name:GIA-CHAU
Last Name:WONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NHAN
Other - Middle Name:GIA
Other - Last Name:CHAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2223 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7523
Mailing Address - Country:US
Mailing Address - Phone:214-783-6611
Mailing Address - Fax:
Practice Address - Street 1:2223 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7523
Practice Address - Country:US
Practice Address - Phone:214-783-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical