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General NPI Number Information
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NPI Number | 1619868148
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Entity Type | Individual
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Provider Name | WAYNE BON WONG
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Gender | Male
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 3364 BEYER BLVD
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City | SAN YSIDRO
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State | CA
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Zip | 92173-1322
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Country | US
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Telephone | 619-205-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 4319 CORRAL CANYON RD
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City | BONITA
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State | CA
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Zip | 91902-3015
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Country | US
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Telephone | 619-957-8258
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 308177
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License Number State | CA
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