Healthcare Provider Details

I. General information

NPI: 1669036257
Provider Name (Legal Business Name): ANTHONY WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-5192
US

IV. Provider business mailing address

9675 BRIGHTON WAY STE 410
BEVERLY HILLS CA
90210-5192
US

V. Phone/Fax

Practice location:
  • Phone: 310-363-8757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberA200971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number28255
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: