Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1124474960 Individual Practitioner Male Practitioner

Brian Wong

Pediatrics • Eagle, ID

Professional Overview & Biography Verified Profile Summary

Brian Wong is a registered healthcare professional specializing in Pediatrics in Eagle, ID. Practice services are available at 3217 W BAVARIA ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

3217 W Bavaria St

Eagle, ID 836165171

Telephone 2083026200
Fax 2083026245
Associated Practice Facility / Clinic
🏢 Oasis Pediatrics Facility NPI 1558641274

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Eagle, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 19.3 Yrs
Regional Practice Density
11 Specialists

Practicing in Eagle, ID (228 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-06-02
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License ID M-14689

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

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.

Secondary Practice Locations

11234 Anderson St, Gme Office Westerly Suite C

Loma Linda, CA 923542804

Phone: 9095584174

3653 N Locust Grove Rd

Meridian, ID 836465924

Phone: 2083386437

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Dr. David Kelly , MD

Family Medicine

NPI 1194862417

Doctor of Medicine (M.D.)

Eric Overton

Family Medicine

NPI 1225448327
NPI 1295998862

Doctor of Medicine (M.D.)

NPI 1699721837

Doctor of Medicine (M.D.)

NPI 1730131905

Doctor of Medicine (M.D.)

Vanessa Bizimana , NP

Nurse Practitioner - Family

NPI 1801008305

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location June 02, 2025

Registered at 3217 W BAVARIA ST, EAGLE, ID 836165171 (Tel: 2083026200)

📍
Updated Business Mailing Address June 02, 2025

Registered at PO BOX 190930, BOISE, ID 837190930 (Tel: 2083675170)

📍
Updated Business Mailing Address June 15, 2019

Registered at 3653 N LOCUST GROVE RD, MERIDIAN, ID 836465924 (Tel: 2083385437)

📍
Updated Practice Location June 04, 2019

Registered at 3653 N LOCUST GROVE RD, MERIDIAN, ID 836465924 (Tel: 2083386437)

NPI Profile Active May 31, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location May 31, 2016

Registered at 11234 ANDERSON ST, GME OFFICE WESTERLY SUITE C, LOMA LINDA, CA 923542804 (Tel: 9095584174)

📍
Updated Business Mailing Address May 31, 2016

Registered at 11234 ANDERSON ST, GME OFFICE WESTERLY SUITE C, LOMA LINDA, CA 923542804 (Tel: 9095584174)

👤
Provider Name / Credentials Updated May 31, 2016

Recorded as BRIAN WONG

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 31, 2016

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration May 11, 2016

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1124474960
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 11, 2016
Last Update: June 02, 2025
Sole Proprietor: No

Mailing Address

Po Box 190930

Boise, ID 837190930

Phone: 2083675170

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.