Provider Demographics
NPI:1538364450
Name:LEECHAWENGWONGS, EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:LEECHAWENGWONGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16821 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-0499
Mailing Address - Country:US
Mailing Address - Phone:360-567-1773
Mailing Address - Fax:360-567-1967
Practice Address - Street 1:16821 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0499
Practice Address - Country:US
Practice Address - Phone:360-567-1773
Practice Address - Fax:360-567-1967
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7557207RA0201X
ORMD157966207RA0201X
WAMD60279701207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology