Provider Demographics
NPI:1710440359
Name:WONG, HIU NAM
Entity Type:Individual
Prefix:MR
First Name:HIU NAM
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TIGER
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23419 17TH AVENUE SOUTHEAST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-599-9542
Mailing Address - Fax:
Practice Address - Street 1:23419 17TH AVENUE SOUTHEAST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:425-599-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer