Healthcare Provider Details

I. General information

NPI: 1912466152
Provider Name (Legal Business Name): ROCHELLE ERIN WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY STE 155
IRVINE CA
92618-3163
US

IV. Provider business mailing address

113 WATERWORKS WAY STE 155
IRVINE CA
92618-3163
US

V. Phone/Fax

Practice location:
  • Phone: 949-612-9090
  • Fax: 949-612-9091
Mailing address:
  • Phone: 949-612-9090
  • Fax: 949-612-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA186762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: