Individual
VINCENZO WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, SUITE 1MC 8.2351, HOUSTON, TX 77030
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
63630
WI
2085R0202X
Diagnostic Radiology Physician
Primary
P6112
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
355484208
—
TX
01
—
355484209
MEDICAID-CSHCN
TX
01
—
8KZ394
BCBS
TX
Enumeration date
02/29/2012
Last updated
06/26/2019
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