Provider Demographics
NPI:1972582369
Name:WONG, JASON KEONI (HSC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:KEONI
Last Name:WONG
Suffix:
Gender:M
Credentials:HSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-4052
Mailing Address - Country:US
Mailing Address - Phone:609-898-6960
Mailing Address - Fax:
Practice Address - Street 1:COMDT (CG-1122)
Practice Address - Street 2:US COAST GUARD 2100 2ND ST SW SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:609-898-6960
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other