Individual
JAKE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8684 15TH AVE, BROOKLYN, NY 11228-3409
(718) 256-5858
(646) 357-1579
Mailing address
17 SOUTHGATE CT, BROOKLYN, NY 11223-5220
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057893
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2014
Last updated
08/13/2015
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