Provider Demographics
NPI:1912972142
Name:WAI, KAI WING (OD)
Entity Type:Individual
Prefix:DR
First Name:KAI
Middle Name:WING
Last Name:WAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:212-226-3372
Practice Address - Street 1:13-17 ELIZABETH ST
Practice Address - Street 2:STE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-226-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C2944OtherHEALTHNET
NYC211E1OtherBLUE CROSS BLUE SHIELD
NY0456754OtherAETNA
NY00883252Medicaid
NY50171POtherHIP
NYP2695762OtherOXFORD
NY5684334OtherCIGNA
NY6599656OtherGHI
NYC211E1OtherBLUE CROSS BLUE SHIELD
NYC32831Medicare ID - Type Unspecified