Healthcare Provider Details

I. General information

NPI: 1124954367
Provider Name (Legal Business Name): ADVANCED INNOVATIVE PATHOLOGY DIAGNOSTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 WHITE OAKS RD
CAMPBELL CA
95008-6723
US

IV. Provider business mailing address

1322 WHITE OAKS RD
CAMPBELL CA
95008-6723
US

V. Phone/Fax

Practice location:
  • Phone: 408-628-4280
  • Fax: 408-628-4283
Mailing address:
  • Phone: 408-628-4280
  • Fax: 408-628-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOROTHY WONG
Title or Position: PARTNER
Credential: MD
Phone: 415-572-5268