Provider Demographics
NPI:1821090903
Name:KWONG, WAI HUNG EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:WAI
Middle Name:HUNG EDMUND
Last Name:KWONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDMUND
Other - Middle Name:
Other - Last Name:KWONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 RIVERVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1864
Mailing Address - Country:US
Mailing Address - Phone:732-530-2468
Mailing Address - Fax:732-345-2010
Practice Address - Street 1:1 RIVERVIEW PLZ
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1864
Practice Address - Country:US
Practice Address - Phone:732-530-2468
Practice Address - Fax:732-345-2010
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042047002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0613606Medicaid
NJF04059Medicare UPIN
NJ0613606Medicaid