Healthcare Provider Details

I. General information

NPI: 1255508131
Provider Name (Legal Business Name): CHARLES DAVID WONG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2008
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 STOCKDALE HWY STE 300
BAKERSFIELD CA
93311-3611
US

IV. Provider business mailing address

PO BOX 2287
BAKERSFIELD CA
93303-2287
US

V. Phone/Fax

Practice location:
  • Phone: 661-664-2200
  • Fax:
Mailing address:
  • Phone: 661-663-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number20A8787
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A8787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: