Provider Demographics
NPI:1982199972
Name:WONG, VIVIAN KA YAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:KA YAN
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8890 N UNION BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2701
Mailing Address - Country:US
Mailing Address - Phone:719-260-1600
Mailing Address - Fax:
Practice Address - Street 1:8890 N UNION BLVD STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2701
Practice Address - Country:US
Practice Address - Phone:719-260-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001887122300000X
CODEN.00204377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist