Healthcare Provider Details

I. General information

NPI: 1174625008
Provider Name (Legal Business Name): CAROLINE WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST SUITE A100
BAKERSFIELD CA
93301-2284
US

IV. Provider business mailing address

PO BOX 11959
BAKERSFIELD CA
93389-3959
US

V. Phone/Fax

Practice location:
  • Phone: 661-869-2600
  • Fax: 661-869-2003
Mailing address:
  • Phone: 661-869-2600
  • Fax: 661-869-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG75701
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG757011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: