Basic Information
| Provider Information | |||||||||
| NPI: | 1275895997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 W CHARLESTON BLVD STE 250 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712355 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1524 PINTO LN | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026383364 | ||||||||
| FaxNumber: | 7023839543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 08/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 15887 | NV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.