Provider Demographics
NPI:1477740934
Name:WONG, ILENE YI-ZHEN (MD)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:YI-ZHEN
Last Name: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 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BLDG B STE 202
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-692-4270
Mailing Address - Fax:610-692-5443
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BLDG B STE 202
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-692-4270
Practice Address - Fax:610-692-5443
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92463390200000X
PAMD439904208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program