Individual
ROUSSELL WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SUDP-T
Contact information
Practice address
113 23RD AVE S, SEATTLE, WA 98144-2309
(206) 219-5980
Mailing address
113 23RD AVE S, SEATTLE, WA 98144-2309
(206) 822-8066
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/19/2021
Last updated
05/10/2021
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