NICOLE SOO WONG MD
NPI 1760060693
Student in an Organized Health Care Education/Training Program in Portland, OR

Q: What is Nicole Wong's NPI number?

The NPI number for Nicole Wong is 1760060693. It was assigned to this individual provider in the NPPES registry on March 31, 2021.

Q: What is Nicole Wong's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Nicole Wong was last updated on March 31, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 31, 2021PECOS Enrolled

3181 SW SAM JACKSON PARK RD # L-579, PORTLAND, OR 97239(503) 494-8211 Get Directions Write a Review

NPPES record last updated: March 31, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Nicole Soo Wong Md NPPES

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

NICOLE SOO WONG MD (NPI 1760060693) is an individual student in an organized health care education/training program in Portland, Oregon and active in the NPI registry since March 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1760060693

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameNICOLE SOO WONGCredential: MD

Location Address3181 SW SAM JACKSON PARK RD # L-579Portland, OR 97239-3098

Mailing Address3181 Sw Sam Jackson Park Rd # L-579Portland, OR 97239-3098 · (956) 693-3588

Phone(503) 494-8211

Sole ProprietorNo

Enumeration DateMarch 31, 2021

NPPES CertifiedMarch 31, 2021

✔ NPI 1760060693 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3181 SW SAM JACKSON PARK RD # L-579, Portland, OR 97239

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Soo Wong Md 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 20

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

DR. CLAIRE MCCORD CONRAD MD

Pediatrics