Healthcare Provider Details

I. General information

NPI: 1568616563
Provider Name (Legal Business Name): PATRICK WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UPPER RAGSDALE DR
MONTEREY CA
93940-5730
US

IV. Provider business mailing address

PO BOX 3168
SALINAS CA
93912-3168
US

V. Phone/Fax

Practice location:
  • Phone: 831-648-7200
  • Fax:
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA114089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: