Provider Demographics
NPI:1689878282
Name:WONG, STEPHEN KWUN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KWUN
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 OLD KATY RD STE 276
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2187
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:281-674-8308
Practice Address - Street 1:7026 OLD KATY RD STE 276
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-621-7436
Practice Address - Fax:281-674-8308
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361252932085R0202X
TXBP1-00265852085R0202X
MO20110099392085R0202X
TXP85692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3846881346OtherMYUTMB 3846881346-COMMERCIAL NUMBER
MO102420003Medicare PIN