Healthcare Provider Details

I. General information

NPI: 1679623730
Provider Name (Legal Business Name): EDMOND YU-PING WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR STE 706
NEWPORT BEACH CA
92660-5927
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 706
NEWPORT BEACH CA
92660-5927
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7733
  • Fax: 949-646-6155
Mailing address:
  • Phone: 949-646-7733
  • Fax: 949-646-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA61834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: