Provider Demographics
NPI:1104130400
Name:WONG, YEE LAN (PA)
Entity type:Individual
Prefix:
First Name:YEE LAN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PA
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:HEMATOLOGY AND ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6805
Mailing Address - Fax:414-805-0618
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF NEOPLASTIC DISEASES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6805
Practice Address - Fax:414-805-0618
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104130400Medicaid
WI73601 1816Medicare PIN