Healthcare Provider Details

I. General information

NPI: 1508001504
Provider Name (Legal Business Name): ARLENE SUSAN WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 METROPOLITAN DR SUITE 301
SAN DIEGO CA
92108-4421
US

IV. Provider business mailing address

PO BOX 927718
SAN DIEGO CA
92192-7718
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-4795
  • Fax:
Mailing address:
  • Phone: 619-278-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG039136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: