Provider Demographics
NPI:1922024769
Name:WONG, JOHNNY C (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:C
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 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5545
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-282-1486
Practice Address - Street 1:7486 RIGHT FLANK RD STE 100
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3834
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041538207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188460OtherANTHEM PROVIDER NUMBER
VA557515OtherAETNA PROVIDER NUMBER
VA290000133OtherMEDICARE RAILROAD
VA7139525OtherMAMSI PROVIDER NUMBER
VA006004580Medicaid
VA021805OtherCIGNA PROVIDER NUMBER
VA4800141OtherUNITED HEALTHCARE PROV #
VA59296OtherSOUTHERN HEALTH PROV #
VA32166OtherCARENET PROVIDER NUMBER
VA32166OtherCARENET PROVIDER NUMBER
VA59296OtherSOUTHERN HEALTH PROV #
VA32166OtherCARENET PROVIDER NUMBER