1780691493 NPI number — HON YUEN WONG, INC

Table of content: (NPI 1780691493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780691493 NPI number — HON YUEN WONG, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HON YUEN WONG, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780691493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
CLARION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16214-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-226-5345
Provider Business Mailing Address Fax Number:
814-226-6060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
CLARION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16214-6278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-5345
Provider Business Practice Location Address Fax Number:
814-226-6060
Provider Enumeration Date:
08/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
HON YUEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-226-5345

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 751893 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007582710009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007582710010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".