Provider Demographics
NPI:1023129426
Name:WONG, WAI SHUN (MD)
Entity type:Individual
Prefix:
First Name:WAI SHUN
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 1:3301 MERCY HEALTH BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1106
Mailing Address - Country:US
Mailing Address - Phone:513-215-9200
Mailing Address - Fax:
Practice Address - Street 1:3301 MERCY HEALTH BLVD STE 125
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211
Practice Address - Country:US
Practice Address - Phone:513-215-9200
Practice Address - Fax:513-215-9259
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090894207R00000X, 207RC0000X, 207RC0001X
WAMD00043721207RC0000X
OH35134077207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease