Active NPI
Tai Yuen Wong, M.B.,CH.B.
- Dermatopathology (Pathology) Physician
- Philadelphia, PA
National Provider Identifier
1275055436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology (Pathology) Physician
- License
- C1-0004382
- Practice address
- 1101 Market St Ste 2820
Philadelphia, PA 19107-2936 - Phone
- (215) 592-9750
- Fax
- (215) 592-0129
- NPI assigned
- Jul 10, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician | 207ZD0900X | C1-0004382 | DE | Primary |
Addresses
Primary practice location
1101 Market St Ste 2820
Philadelphia, PA 19107-2936
Mailing address
1101 Market St Ste 2820
Philadelphia, PA 19107-2936
Phone (215) 704-7177
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1-0004382 | DE | MD | Dermatopathology (Pathology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523577600000",
"number": "1275055436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 MARKET ST STE 2820",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191072936",
"telephone_number": "215-704-7177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 MARKET ST STE 2820",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191072936",
"telephone_number": "215-592-9750",
"fax_number": "215-592-0129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "TAI",
"middle_name": "YUEN",
"name_prefix": "Dr.",
"credential": "M.B.,CH.B.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-10",
"last_updated": "2018-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "DE",
"license": "C1-0004382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.