Provider Demographics
NPI:1538328075
Name:WONG, YEUK TING BONNIE (MD)
Entity type:Individual
Prefix:
First Name:YEUK TING
Middle Name:BONNIE
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 1:6261 LANCASTER PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9167
Mailing Address - Country:US
Mailing Address - Phone:317-344-2019
Mailing Address - Fax:
Practice Address - Street 1:5550 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1991
Practice Address - Country:US
Practice Address - Phone:317-534-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068060A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200990230Medicaid
IN200990230Medicaid
INM400021958Medicare PIN