Provider Demographics
NPI:1952379588
Name:WONG-SICK-HONG, JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:
Last Name:WONG-SICK-HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-488-6653
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:3340 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5069
Practice Address - Country:US
Practice Address - Phone:918-687-6002
Practice Address - Fax:918-687-6216
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18881207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100060920AMedicaid
OK378969147Medicare PIN