Healthcare Provider Details

I. General information

NPI: 1891254132
Provider Name (Legal Business Name): LYE-YENG WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 QUARRY RD
PALO ALTO CA
94304
US

IV. Provider business mailing address

870 QUARRY RD
PALO ALTO CA
94304
US

V. Phone/Fax

Practice location:
  • Phone: 281-770-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA207934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: