Provider Demographics
NPI:1699743674
Name:WONGSA, PEGGY (MD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:WONGSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAKKINEE
Other - Middle Name:
Other - Last Name:SRIWATANAWONGSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21212 NORTHWEST FWY STE 215
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5885
Mailing Address - Country:US
Mailing Address - Phone:281-897-1122
Mailing Address - Fax:281-897-0777
Practice Address - Street 1:21212 NORTHWEST FWY STE 215
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5885
Practice Address - Country:US
Practice Address - Phone:281-897-1122
Practice Address - Fax:281-897-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092170203Medicaid
TX092170203Medicaid
F94200Medicare UPIN