| Doctor Name: | KENNETH EDWARD WONG |
| NPI Number: | 1215935986 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 11066R |
| Business Practice Address: | 102 Twin Oaks Dr Raceland, LA - 703942760 |
| Business Phone Number: | 9858374000 |
| Business Fax Number: | 9855374074 |
| Mailing Address: | Po Box 4176, HOUMA |
| State: | LA |
| Postal Code: | 703614176 |
| Phone Number: | 9858760300 |
| Fax Number: | 9858720317 |
| NPI Enumeration Date: | 07/07/2005 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | 11066R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |