Provider Demographics
NPI:1972689966
Name:MAN-WONG, KATHY KWOK FUN (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:KWOK FUN
Last Name:MAN-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 1:757 55TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-437-9282
Mailing Address - Fax:718-437-9284
Practice Address - Street 1:757 55TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-437-9282
Practice Address - Fax:718-437-9282
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204163174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000028656OtherAFFINITY
NY204163OtherHEALTH FIRST
NY319310201OtherHEALTH PLUS
NY03463AOtherGHI MEDICARE
NY33120POtherHIP
NY239415OtherWELLCARE
NY01934156Medicaid
NYP2179335OtherOXFORD HEALTH PLAN
NY319310201OtherHEALTH PLUS