MEDICARE: DR. JASON T 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	208600000X	Surgery Physician	227262	MA
2	208600000X	Surgery Physician	A113420	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780641704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON T WONG M.D.

Provider Business Mailing Address
First Line	:	24411 HEALTH CENTER DR
Second Line	:	SUITE 350
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3651
Country	:	US
Telephone Number	:	310-923-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	24411 HEALTH CENTER DR
Second Line	:	SUITE 350
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3651
Country	:	US
Telephone Number	:	310-923-4556
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	09/10/2013

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