Healthcare Provider Details

I. General information

NPI: 1316130321
Provider Name (Legal Business Name): JEFFREY A WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

500 ALA MOANA BLVD SUITE 1-302
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7237
  • Fax:
Mailing address:
  • Phone: 808-528-3657
  • Fax: 808-524-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4804
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberA104571
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA104571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: