Individual
STACEY C WONG
Active
Individual
STACEY C WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00024920
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039587
LABOR & INDUSTRY
WA
01
—
805135200
IDAHO MEDICAID
WA
05
—
8303786
—
WA
01
—
US0861513
AETNA/USHC SPECIALIST
WA
01
—
WO6512
BLUE SHIELD
WA
Enumeration date
08/23/2006
Last updated
02/07/2011
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