MEDICARE: ANDREW WONG M.D.

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	207Q00000X	Family Medicine Physician	52842	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619314796	OTHER		NPI

General Provider Information

NPI Number	:	1619314796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WONG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	3477 S MERCY RD STE 201
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-0448
Country	:	US
Telephone Number	:	480-728-6580
Fax Number	:	480-728-6581

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

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	09/18/2025

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