Basic Information
| Provider Information | |||||||||
| NPI: | 1316206691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | HUGH | ||||||||
| MiddleName: | PHONG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8035 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672080035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166899135 | ||||||||
| FaxNumber: | 3166899769 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 N CARRIAGE PKWY | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672084500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166512250 | ||||||||
| FaxNumber: | 3166899391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2012 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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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 | 207QS1201X | 04-39317 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 207Q00000X | 4301100415 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 4301100415 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.