| Entity Name: | TZEWAN WONG, MD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 18 Jul 2002 (23 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P02000078294 |
| FEI/EIN Number | 68-0513233 |
| Mail Address: | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Address: | 10420 SW 77TH AVENUE, SUITE 100, MIAMI, FL 33156 |
| ZIP code: | 33156 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700806312 | 2006-07-20 | 2012-06-25 | 10420 SW 77TH AVE, 100, PINECREST, FL, 331563771, US | 10420 SW 77TH AVE, 100, PINECREST, FL, 331563771, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-668-4484 |
| Fax | 3056684994 |
Authorized person
| Name | DR. TZEWAN WONG |
| Role | DOCTOR |
| Phone | 3056684484 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME0054738 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 042867100 |
| State | FL |
| Issuer | B/C B/S |
| Number | 08766 |
| State | FL |
| Issuer | AVMED |
| Number | 208767 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WONG, ALICE | Agent | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| WONG, TZEWAN MD | President | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| WONG, TZEWAN MD | Director | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| WONG, ALICE | SECRETARY | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Name | Role | Address |
|---|---|---|
| WONG, ALICE | DIRECTOR | 9780 SW 145TH STREET, MIAMI, FL 33176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-26 | WONG, ALICE | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-03-21 | 10420 SW 77TH AVENUE, SUITE 100, MIAMI, FL 33156 | No data |
| CHANGE OF MAILING ADDRESS | 2010-03-21 | 10420 SW 77TH AVENUE, SUITE 100, MIAMI, FL 33156 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-30 |
| ANNUAL REPORT | 2014-05-01 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-05-01 |
| ANNUAL REPORT | 2011-04-19 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
