Provider Demographics
NPI:1942201025
Name:PHOON, WAI WOR (MD)
Entity Type:Individual
Prefix:DR
First Name:WAI
Middle Name:WOR
Last Name:PHOON
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 1:314 E MAIN ST
Mailing Address - Street 2:STE. 402, KELWAY PLAZA
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-731-1006
Mailing Address - Fax:302-731-1007
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:STE. 402, KELWAY PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-731-1006
Practice Address - Fax:302-731-1007
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0000672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000019707Medicaid
DE0000019707Medicaid
DEB66245Medicare UPIN