Individual
KEVAN L WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4144 N CENTRAL EXPY, STE 360, DALLAS, TX 75204-2156
(214) 827-7460
(214) 826-6858
Mailing address
4144 N CENTRAL EXPY, STE 360, DALLAS, TX 75204-2156
(214) 827-7460
(214) 826-6858
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L1243
TX
207L00000X
Anesthesiology Physician
Primary
L1243
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040825401
—
TX
05
—
040825404
—
TX
01
—
8EH854
BCBS
TX
01
—
P01446832
RR
TX
Enumeration date
06/15/2005
Last updated
11/03/2015
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