Provider Demographics
NPI:1215911292
Name:WONG, GENE K (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3442
Mailing Address - Country:US
Mailing Address - Phone:509-946-9664
Mailing Address - Fax:509-943-5249
Practice Address - Street 1:1215 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3442
Practice Address - Country:US
Practice Address - Phone:509-946-9664
Practice Address - Fax:509-943-5249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD17852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1526904Medicaid
WA65 129OtherGROUP HEALTH
WA7199904Medicaid
WA1526904Medicaid