Provider Demographics
NPI:1780628966
Name:WONG, WAYLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYLAND
Middle Name:
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 1:2020 E STATE ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2480
Mailing Address - Country:US
Mailing Address - Phone:330-332-4900
Mailing Address - Fax:330-332-4903
Practice Address - Street 1:2020 E STATE ST
Practice Address - Street 2:SUITE G
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2480
Practice Address - Country:US
Practice Address - Phone:330-332-4900
Practice Address - Fax:330-332-7724
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094756207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3022679Medicaid
OH3022679Medicaid