Healthcare Provider Details

I. General information

NPI: 1164041737
Provider Name (Legal Business Name): STEPHANIE G. WONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200A
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200A
NEWPORT BEACH CA
92663-3664
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8070
  • Fax: 949-650-4585
Mailing address:
  • Phone: 949-764-8070
  • Fax: 949-650-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number20A25842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: