Individual
VINCENZO WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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