Provider Demographics
NPI:1962210971
Name:WONG, KIMBERLY (RN)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31-23 68TH ST
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1224
Mailing Address - Country:US
Mailing Address - Phone:347-244-6544
Mailing Address - Fax:
Practice Address - Street 1:31-23 68TH ST
Practice Address - Street 2:2 FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1224
Practice Address - Country:US
Practice Address - Phone:347-244-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2629415163WI0500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty