Provider Demographics
NPI:1679766323
Name:WONG, PETER KAM-HO (MS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:KAM-HO
Last Name:WONG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 80TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3522
Mailing Address - Country:US
Mailing Address - Phone:206-230-9181
Mailing Address - Fax:
Practice Address - Street 1:2000 116TH AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3047
Practice Address - Country:US
Practice Address - Phone:206-356-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00050778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist