Individual
SO CHING WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1113 S MAIN ST, SUITE C, CHESHIRE, CT 06410-3436
(203) 271-2552
(203) 271-3301
Mailing address
1113 S MAIN ST, SUITE C, CHESHIRE, CT 06410-3436
(203) 271-2552
(203) 271-3301
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
000541
CT
213ES0131X
Foot Surgery Podiatrist
Primary
000541
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004113411
—
CT
01
—
480000693
MEDICARE
—
Enumeration date
07/28/2006
Last updated
12/11/2008
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