Individual
BANNY SHING-CHI WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 SE 172ND AVE, SUITE 130, VANCOUVER, WA 98684-9542
(360) 882-2778
(360) 604-1712
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49892
MN
207RG0100X
Gastroenterology Physician
MD158067
OR
207RG0100X
Gastroenterology Physician
Primary
MD60623525
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972724227
—
WA
05
—
ENROLLED
—
MN
01
—
P00839015
MEDICARE, RAILROAD
MN
Enumeration date
05/02/2007
Last updated
03/16/2016
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