Healthcare Provider Details

I. General information

NPI: 1235114703
Provider Name (Legal Business Name): MICHAEL SHELDON WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD.
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2221 STOCKTON BLVD SUITE 2123
SACRAMENTO CA
95817-1418
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2130
  • Fax: 916-734-7104
Mailing address:
  • Phone: 916-734-2130
  • Fax: 916-734-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberG78666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: