Provider Demographics
NPI:1356439087
Name:WONG, CHUN-KWOK (MD)
Entity type:Individual
Prefix:
First Name:CHUN-KWOK
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 1:9200 PINECROFT DR
Mailing Address - Street 2:SUITE 470
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3279
Mailing Address - Country:US
Mailing Address - Phone:281-719-5951
Mailing Address - Fax:281-719-5958
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:SUITE 470
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-719-5951
Practice Address - Fax:281-719-5958
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5216207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117269405Medicaid
TX117269405Medicaid
TXTXB102875Medicare PIN