Brian Wong

Pediatrics Physician · Eagle, ID

Individual Active NPI

NPI number 1124474960

Practice location

3217 W Bavaria St
Eagle, ID 83616-5171
Phone
(208) 302-6200
Fax
(208) 302-6245

Open in Google Maps

NPI record

NPI
1124474960
Entity type
Individual (Type 1)
Enumeration date
May 11, 2016
Last updated
June 2, 2025
Certified
June 2, 2025
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatrics Physician Primary 208000000X M-14689 ID
Student in an Organized Health Care Education/Training Program 390200000X — —

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone
(208) 367-5170

Other practice locations (2)

  • 11234 Anderson St, GME Office Westerly Suite C, Loma Linda, CA 92354-2804 · (909) 558-4174
  • 3653 N Locust Grove Rd, Meridian, ID 83646-5924 · (208) 338-6437

About Brian Wong

Brian Wong is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatrics Physician (code 208000000X). The practice location is 3217 W Bavaria St, Eagle, ID 83616-5171. The NPI number 1124474960 was assigned on May 11, 2016 and the record was last updated on June 2, 2025.

Brian Wong lists a license in the registry: #M-14689 (ID) for Pediatrics Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Brian Wong?

The NPI number is 1124474960.

What is the phone number of Brian Wong?

The phone number listed for the practice location is (208) 302-6200.

Where is Brian Wong located?

3217 W Bavaria St, Eagle, ID 83616-5171.

What is the taxonomy code for Brian Wong?

The primary taxonomy code is 208000000X – Pediatrics Physician; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

Other Pediatrics Physician providers in Eagle

All Pediatrics Physician providers in Eagle, ID →