Healthcare Provider Details

I. General information

NPI: 1033203500
Provider Name (Legal Business Name): JOANNE HAY-LING WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

IV. Provider business mailing address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20847
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: