=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124954367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED INNOVATIVE PATHOLOGY DIAGNOSTICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2026
-----------------------------------------------------
Last Update Date | 06/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 WHITE OAKS RD
-----------------------------------------------------
City | CAMPBELL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95008-6723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-628-4280
-----------------------------------------------------
Fax | 408-628-4283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1322 WHITE OAKS RD
-----------------------------------------------------
City | CAMPBELL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95008-6723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-628-4280
-----------------------------------------------------
Fax | 408-628-4283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. DOROTHY WONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-572-5268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------