Brian Wong Valid NPI

Individual provider · Pediatrics Physician · Eagle, ID

NPI

1124474960

Type

Individual (Type 1)

Primary specialty

Pediatrics Physician (Pediatrics)

Specialty group

Allopathic & Osteopathic Physicians

Taxonomy code

208000000X

License number

M-14689 (ID)

Sex

Male

Sole proprietor

No

Enumerated

2016-05-11

Last updated

2025-06-02