Healthcare Provider Details

I. General information

NPI: 1528120904
Provider Name (Legal Business Name): FOOK Y WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRANK FOOK Y WONG M.D.

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE SUITE 104
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N JACKSON AVE SUITE 104
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-6566
  • Fax: 408-258-6660
Mailing address:
  • Phone: 408-258-6566
  • Fax: 408-258-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG66621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: