Provider Demographics
NPI:1760479323
Name:WONG, JACQUELINE W (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:W
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:945 HILDEBRAND LN NE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2877
Mailing Address - Country:US
Mailing Address - Phone:360-621-9970
Mailing Address - Fax:206-257-0983
Practice Address - Street 1:945 HILDEBRAND LN NE
Practice Address - Street 2:SUITE 235
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2877
Practice Address - Country:US
Practice Address - Phone:360-621-9970
Practice Address - Fax:206-257-0983
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2013-07-31
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039827207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology