Provider Demographics
NPI:1972669919
Name:WONG, SUNNY (MD)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
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:PO BOX 451268
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-791-0425
Mailing Address - Fax:
Practice Address - Street 1:MCPHERSON MEDICAL CENTER
Practice Address - Street 2:6801 MCPHERSON ROAD SUITE 337
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040
Practice Address - Country:US
Practice Address - Phone:956-791-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3201207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00OV97Medicare ID - Type Unspecified
C23719Medicare UPIN