Provider Demographics
NPI:1386719029
Name:WONG, ANNA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N DIVISION ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-4931
Mailing Address - Country:US
Mailing Address - Phone:253-333-1637
Mailing Address - Fax:253-351-8509
Practice Address - Street 1:121 N DIVISION ST
Practice Address - Street 2:SUITE 340
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4931
Practice Address - Country:US
Practice Address - Phone:253-333-1637
Practice Address - Fax:253-351-8509
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010847872084N0400X
WAMD000472902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology