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General NPI Number Information
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NPI Number | 1194900498
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Entity Type | Individual
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Provider Name | GILBERT C WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 3895 W 7800 S SUITE 202
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City | WEST JORDAN
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State | UT
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Zip | 84088-5617
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Country | US
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Telephone | 801-948-4442
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Fax |
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Provider Business Mailing Address
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Address Line | 3895 W 7800 S SUITE 202
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City | WEST JORDAN
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State | UT
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Zip | 84088-5617
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Country | US
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Telephone | 801-948-4442
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 6825165-1205
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License Number State | UT
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