MEDICARE: DR. ERNEST WONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	34797	CA

General Provider Information

NPI Number	:	1073656997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST WONG DDS

Provider Business Mailing Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-587-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 EXECUTIVE DR
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3018
Country	:	US
Telephone Number	:	858-587-2828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ERNEST WONG DDS” Practice Location

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