Provider Demographics
NPI:1821269580
Name:WONG FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WONG FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:HON
Authorized Official - Middle Name:YUEN
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-738-6880
Mailing Address - Street 1:751 ROCKVILLE PIKE
Mailing Address - Street 2:13A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1142
Mailing Address - Country:US
Mailing Address - Phone:301-738-6880
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:#210
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-681-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty