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General NPI Number Information
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NPI Number | 1528555869
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Entity Type | Individual
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Provider Name | THOMAS WONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2330 UTAH AVE STE 200
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4817
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Country | US
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Telephone | 281-766-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 S OSPREY AVE UNIT 101
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City | SARASOTA
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State | FL
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Zip | 34239-3608
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Country | US
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Telephone |
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 63753
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME19350
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License Number State | FL
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