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General NPI Number Information
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NPI Number | 1427572916
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Entity Type | Individual
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Provider Name | MICHAEL GAHAO WONG DDS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11549 SOUTH ST
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-278-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 12735 SALINAZ DR
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4224
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Country | US
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Telephone | 714-548-2861
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 101695
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License Number State | CA
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