Provider Demographics
NPI:1780691493
Name:HON YUEN WONG, INC
Entity type:Organization
Organization Name:HON YUEN WONG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HON YUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-226-5345
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-6278
Mailing Address - Country:US
Mailing Address - Phone:814-226-5345
Mailing Address - Fax:814-226-6060
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-6278
Practice Address - Country:US
Practice Address - Phone:814-226-5345
Practice Address - Fax:814-226-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA751893OtherBLUE CROSS
PA1007582710009Medicaid
PA1007582710010Medicaid
PA033156Medicare ID - Type Unspecified