Provider Demographics
NPI:1962494989
Name:WO, CHAI-LUK (MD)
Entity Type:Individual
Prefix:
First Name:CHAI-LUK
Middle Name:
Last Name:WO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:14351 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6155
Mailing Address - Country:US
Mailing Address - Phone:718-461-3823
Mailing Address - Fax:718-461-3823
Practice Address - Street 1:14351 ROOSEVELT AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6155
Practice Address - Country:US
Practice Address - Phone:718-461-3823
Practice Address - Fax:718-461-3823
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY167935207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00975448Medicaid
NY00975448Medicaid
A64359Medicare UPIN
NY80D963Medicare ID - Type Unspecified
NY25225Medicare ID - Type UnspecifiedGH1