Provider Demographics
NPI:1902079429
Name:WONG, CHI WAI (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHI WAI
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115A DIVISION ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6103
Mailing Address - Country:US
Mailing Address - Phone:212-233-8868
Mailing Address - Fax:
Practice Address - Street 1:115A DIVISION ST # A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6103
Practice Address - Country:US
Practice Address - Phone:212-233-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist