Healthcare Provider Details

I. General information

NPI: 1912822321
Provider Name (Legal Business Name): BRIAN N WONG
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 BARRANCA PKWY STE 150
IRVINE CA
92604-8652
US

IV. Provider business mailing address

PO BOX 15013
IRVINE CA
92623-5013
US

V. Phone/Fax

Practice location:
  • Phone: 949-551-0661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: