Nathan Gee Yut Wong, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14553 Issued in MN

Practice address

7200 Hemlock LN N Ste 105
Maple Grove, MN 55369-5587

Phone

(763) 424-4415

NPI assigned

May 17, 2021

Last updated

Jun 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fu Wong DDS PA

  dba Lakeland Family Dental

  • Dentist
  • Maple Grove, MN
  • NPI 1750556627
  NPD (past)

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

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1548834385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 COVEY TRL",
            "city": "MEDINA",
            "state": "MN",
            "postal_code": "553404000",
            "telephone_number": "763-210-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 HEMLOCK LN N STE 105",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695587",
            "telephone_number": "763-424-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "NATHAN",
        "middle_name": "GEE YUT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-17",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Wolfgramm
• Claire Wolters
• Ashley Wong, AU.D.
• Fu Wong, DDS
• Jonathan Gee Hin Wong
• Stacy Adair Woodard
• Barbara Wormington
• Angel Wright
• Susan Mentjes Wrobel, NP
• Lucas Walker Wyatt, LPCC

• Dentist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.