Individual
BRIAN STEPHEN WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3906 S DUPONT SQ, LOUISVILLE, KY 40207-4647
(812) 282-3899
(812) 282-4172
Mailing address
3906 S DUPONT SQ, LOUISVILLE, KY 40207-4647
(812) 282-3899
(812) 282-4172
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
01094584A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
59042
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100969980
—
KY
01
—
K0009669
MEDICARE
KY
Enumeration date
03/22/2018
Last updated
08/27/2024
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