Provider Demographics
NPI:1780422147
Name:WONG, EMILY GA PUI
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GA PUI
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PIKE RD APT 15102
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8995
Mailing Address - Country:US
Mailing Address - Phone:808-469-8209
Mailing Address - Fax:
Practice Address - Street 1:10280 W 55TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-4925
Practice Address - Country:US
Practice Address - Phone:303-914-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant