Healthcare Provider Details

I. General information

NPI: 1396705356
Provider Name (Legal Business Name): CHING YEE WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHING-YEE WONG MD

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EXPO PKWY SUTTER HEALTH IMAGING
SACRAMENTO CA
95815-4227
US

IV. Provider business mailing address

1500 EXPO PKWY SUTTER HEALTH IMAGING
SACRAMENTO CA
95815-4227
US

V. Phone/Fax

Practice location:
  • Phone: 248-701-8979
  • Fax:
Mailing address:
  • Phone: 248-701-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number4301073055
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberC144795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: