Chung Kwang Raymond Wong, D.D.S., M.S.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009381 Issued in IN

Practice address

6920 Parkdale PL
Suite 217
Indianapolis, IN 46254-5612

Phone

(317) 328-6708

Fax

(317) 328-6888

NPI assigned

Sep 26, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316048689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 PARKDALE PL",
            "address_2": "SUITE 217",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545612",
            "telephone_number": "317-328-6708",
            "fax_number": "317-328-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6920 PARKDALE PL",
            "address_2": "SUITE 217",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545612",
            "telephone_number": "317-328-6708",
            "fax_number": "317-328-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "CHUNG KWANG",
        "middle_name": "RAYMOND",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12009381A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Women'S Physician Surgery Center, LLC
• Michael Anthony Womersley Jr., PHARM.D.
• Komivi Womitso, MD
• Alvin Gibson Wong, M.D.
• Carina Wong
• Ian Wong, MD
• Katie Wong, MD
• L Richard Wong, DC
• Leah Wong, FNP-C
• Taylor Wong

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.