Provider Demographics
NPI:1396159570
Name:WONG, DANIEL WEI HUEN (NP-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WEI HUEN
Last Name:WONG
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 WADE HAMPTON BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4893 WADE HAMPTON BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5247
Practice Address - Country:US
Practice Address - Phone:864-590-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily