Healthcare Provider Details

I. General information

NPI: 1336916295
Provider Name (Legal Business Name): MELANIE LOK-YAN WONG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 MEDICAL CENTER RD
MISSION VIEJO CA
92691-6426
US

IV. Provider business mailing address

15 AVIGNON AVE
FOOTHILL RANCH CA
92610-1918
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1400
  • Fax:
Mailing address:
  • Phone: 949-273-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: