Provider Demographics
NPI:1962503748
Name:WONG, CECELIA HSUN (MD)
Entity Type:Individual
Prefix:DR
First Name:CECELIA
Middle Name:HSUN
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 HIATUS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5870 HIATUS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6424
Practice Address - Country:US
Practice Address - Phone:954-377-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084623208M00000X
FLME 126689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01665322Medicaid
OH2528107Medicaid
4149322Medicare PIN
OH2528107Medicaid
I23187Medicare UPIN