Healthcare Provider Details

I. General information

NPI: 1144524232
Provider Name (Legal Business Name): CURTIS SF WONG, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SISTER MARY COLUMBA DR SUITE 200
RED BLUFF CA
96080-4356
US

IV. Provider business mailing address

2440 SISTER MARY COLUMBA DR SUITE 200
RED BLUFF CA
96080-4356
US

V. Phone/Fax

Practice location:
  • Phone: 530-690-2424
  • Fax: 530-690-2426
Mailing address:
  • Phone: 530-690-2424
  • Fax: 530-690-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG74386
License Number StateCA

VIII. Authorized Official

Name: DR. CURTIS SF WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 530-690-2424