Provider Demographics
NPI:1700982170
Name:WONG, CHIT (DO)
Entity Type:Individual
Prefix:
First Name:CHIT
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 CREEKSTONE LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-628-5372
Mailing Address - Fax:713-540-8897
Practice Address - Street 1:9737 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4067
Practice Address - Country:US
Practice Address - Phone:281-540-8896
Practice Address - Fax:281-540-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A8869OtherLEGACY NUMBER
H88837Medicare UPIN
8A8869OtherLEGACY NUMBER