Individual
JONATHAN Y WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2700
(360) 414-2714
Mailing address
PO BOX 249, LONGVIEW, WA 98632-7154
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004614
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186400
LABOR & IND
WA
05
—
8388456
—
WA
01
—
8938464
CRIME VICTIMS
WA
Enumeration date
09/08/2005
Last updated
07/08/2007
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