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General NPI Number Information
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NPI Number | 1043394364
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Entity Type | Individual
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Provider Name | MICHAEL L WONG D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 401 GRAND AVENUE 370
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City | OAKLAND
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State | CA
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Zip | 94610-5046
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Country | US
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Telephone | 510-444-1116
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Fax | 510-444-1180
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Provider Business Mailing Address
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Address Line | 15520 ROCKFIELD BLVD A200
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City | IRVINE
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State | CA
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Zip | 92618-6705
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Country | US
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Telephone | 949-598-9999
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Fax | 949-598-9990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC15075
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License Number State | CA
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