Individual
JACKSON WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-4096
Mailing address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-4096
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11416306-1205
UT
Other
Enumeration date
03/25/2018
Last updated
09/17/2019
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