Provider Demographics
NPI:1710780101
Name:WONG, JOVI (MD)
Entity type:Individual
Prefix:DR
First Name:JOVI
Middle Name:
Last Name:WONG
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 1:8820 LADUE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-367-1181
Mailing Address - Fax:
Practice Address - Street 1:1600 S. BRENTWOOD BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-367-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program