Healthcare Provider Details

I. General information

NPI: 1760643514
Provider Name (Legal Business Name): YU-TUNG WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR DIVISION OF HEAD AND NECK SURGERY, #8895
SAN DIEGO CA
92103
US

IV. Provider business mailing address

200 W ARBOR DR DIVISION OF HEAD AND NECK SURGERY, #8895
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax: 619-471-0286
Mailing address:
  • Phone: 619-543-1967
  • Fax: 619-471-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number126098
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA126098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: