Active NPI
Kenneth Wong, DDS
- Dentist
- Litchfield Park, AZ
National Provider Identifier
1376683425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6346
- Practice address
- 13575 W Indian School Rd
Suite 300
Litchfield Park, AZ 85340-4901 - Phone
- (623) 536-7789
- Fax
- (623) 536-4743
- NPI assigned
- Feb 7, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6346 | AZ | Primary |
Addresses
Primary practice location
13575 W Indian School Rd
Suite 300
Litchfield Park, AZ 85340-4901
Mailing address
13575 W Indian School Rd
Suite 300
Litchfield Park, AZ 85340-4901
Phone (623) 536-7789
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D6346 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150902001661 | AZ | Order and Referring Only - Dentist | 3678889839 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6346 | AZ | MD | Pulmonary Rehabilitation Certified Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193616000000",
"number": "1376683425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13575 W INDIAN SCHOOL RD",
"address_2": "SUITE 300",
"city": "LITCHFIELD PARK",
"state": "AZ",
"postal_code": "853404901",
"telephone_number": "623-536-7789",
"fax_number": "623-536-4743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13575 W INDIAN SCHOOL RD",
"address_2": "SUITE 300",
"city": "LITCHFIELD PARK",
"state": "AZ",
"postal_code": "853404901",
"telephone_number": "623-536-7789",
"fax_number": "623-536-4743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2007-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "6346",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D6346",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Litchfield Park, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.