Provider Demographics
NPI:1982699393
Name:WONG, AGNES (MD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21600 HWY 99
Mailing Address - Street 2:SUITE 290
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8012
Mailing Address - Country:US
Mailing Address - Phone:425-778-0191
Mailing Address - Fax:425-672-2110
Practice Address - Street 1:21600 HWY 99
Practice Address - Street 2:SUITE 290
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8012
Practice Address - Country:US
Practice Address - Phone:425-778-0191
Practice Address - Fax:425-672-2110
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000285062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine