DR. RUDOLPH JOU WONG M.D. - NPI 1639563604

Q: What is Rudolph Wong's NPI number?

The NPI number for Rudolph Wong is 1639563604. It was assigned to this individual provider in the NPPES registry on March 26, 2015.

Q: What is Rudolph Wong's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Critical Care Medicine, with taxonomy code 2080P0203X.

Q: When was this NPI record last updated?

The NPPES record for Rudolph Wong was last updated on April 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Dr. Rudolph Jou Wong M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. RUDOLPH JOU WONG M.D. (NPI 1639563604) is an individual pediatric critical care medicine provider in Dallas, Texas, licensed in Texas (R5230) and active in the NPI registry since March 2015. He is enrolled in Medicare PECOS and maintains a secondary practice location in Phoenix.

NPPES Registry Identity

NPI1639563604

Entity TypeIndividualMale

Primary Taxonomy2080P0203X

Provider Legal NameDR. RUDOLPH JOU WONGCredential: M.D.

Location Address7777 FOREST LN STE C300JDallas, TX 75230-2604

Mailing Address7777 Forest Ln Ste C300jDallas, TX 75230-2604 · (972) 566-2043 · Fax (972) 566-7437

Phone(972) 566-2043

Fax(972) 566-7437

Sole ProprietorNo

Enumeration DateMarch 26, 2015

Last NPPES UpdateApril 7, 20232 updates tracked since enumeration

NPPES CertifiedApril 7, 2023

✔ NPI 1639563604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Critical Care MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0203X

Licenses✔ Licensed in TX · R5230✔ Licensed in AZ · 55855

Definition

A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.

Also ListedPediatricsTaxonomy 208000000X · License 55855 (AZ)

7777 FOREST LN STE C300J, Dallas, TX 75230

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Secondary Practice Location 1

Location 11919 E Thomas RdPhoenix, AZ 85016-7710 · Phone (602) 933-1000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Rudolph Jou Wong M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DARINKA-STEFKA SAVOR AG-ACNP-BC

Nurse Practitioner (Acute Care)