Basic Information
| Provider Information | |||||||||
| NPI: | 1952613283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | HALEI | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4881 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | WRIGHT PATTERSON AFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454335529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372571160 | ||||||||
| FaxNumber: | 9372573012 | ||||||||
| Practice Location | |||||||||
| Address1: | 4881 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | WRIGHT PATTERSON AFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454335529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372571160 | ||||||||
| FaxNumber: | 4052718547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VF0040X | 33593 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 207V00000X | 29833 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.