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General NPI Number Information
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NPI Number | 1235299538
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Entity Type | Organization
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Legal Business Name | I. LANE WONG, M.D. INC.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 ALTON PKWY STE 201
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City | IRVINE
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State | CA
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Zip | 92606-5034
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Country | US
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Telephone | 949-387-3888
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Fax | 949-387-3907
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Provider Business Mailing Address
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Address Line | 2500 ALTON PKWY STE 201
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City | IRVINE
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State | CA
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Zip | 92606-5034
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Country | US
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Telephone | 949-387-3888
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Fax | 949-387-3907
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. AUDREY J WONG
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Credential |
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Telephone | 949-387-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | G59317
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License Number State | CA
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