Provider Demographics
NPI:1962444885
Name:WONG, ROGER Y (DO)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:Y
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-243-1100
Mailing Address - Fax:206-431-0835
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 501
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-2611
Practice Address - Fax:206-242-3640
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000713207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8292682Medicaid
WAP00673152OtherMEDICARE RAILROAD
WAAB8870279Medicare PIN
WAC30612Medicare UPIN