Provider Demographics
NPI:1639563604
Name:WONG, RUDOLPH JOU (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:JOU
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LN STE C300J
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2604
Mailing Address - Country:US
Mailing Address - Phone:972-566-2043
Mailing Address - Fax:972-566-7437
Practice Address - Street 1:7777 FOREST LN STE C300J
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2604
Practice Address - Country:US
Practice Address - Phone:972-566-2043
Practice Address - Fax:972-566-7437
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ55855208000000X, 2080P0203X
TXR52302080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics