Active NPI
Kelvin Karl Yu Wong, M.D.
- Family Medicine Physician
- Everett, WA
National Provider Identifier
1003178567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD60281872
- Practice address
- 3901 Hoyt Ave
Everett, WA 98201-4918 - Phone
- (425) 259-0966
- NPI assigned
- Jun 11, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD60281872 | WA | Primary |
Addresses
Primary practice location
3901 Hoyt Ave
Everett, WA 98201-4918
Mailing address
PO Box 5127
Everett, WA 98206-5127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2022435 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491782400000",
"number": "1003178567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5127",
"city": "EVERETT",
"state": "WA",
"postal_code": "982065127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 HOYT AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014918",
"telephone_number": "425-259-0966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "KELVIN KARL",
"middle_name": "YU",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-11",
"last_updated": "2017-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD60281872",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2022435",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.