Individual
KENNETH EDWARD WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 TWIN OAKS DR, RACELAND, LA 70394-2760
(985) 837-4000
(985) 537-4074
Mailing address
PO BOX 4176, HOUMA, LA 70361-4176
(985) 876-0300
(985) 872-0317
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11066R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060048455
RR MEDICARE
LA
05
—
1663522
—
LA
Enumeration date
07/07/2005
Last updated
10/19/2015
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