Healthcare Provider Details

I. General information

NPI: 1518585447
Provider Name (Legal Business Name): ALEXANDER F WONG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 BRIMHALL RD
BAKERSFIELD CA
93312-2779
US

IV. Provider business mailing address

9710 BRIMHALL RD
BAKERSFIELD CA
93312-2779
US

V. Phone/Fax

Practice location:
  • Phone: 661-829-6747
  • Fax: 661-520-4050
Mailing address:
  • Phone: 661-829-6747
  • Fax: 661-520-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9113307
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: