Doctor Name: | DR. CHARLES MEN WONG |
NPI Number: | 1659394187 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MD14849 |
Business Practice Address: | 2850 Se Powell Valley Rd Gresham, OR - 970801494 |
Business Phone Number: | 5036665050 |
Business Fax Number: | 5036667410 |
Mailing Address: | Po Box 647, GRESHAM |
State: | OR |
Postal Code: | 970300167 |
Phone Number: | 5036665050 |
Fax Number: | 5036667410 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD14849 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |