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General NPI Number Information
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NPI Number | 1740495712
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Entity Type | Individual
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Provider Name | TIFFANY WONG M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 800-382-8387
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 S SIERRA VISTA AVE
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City | ALHAMBRA
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State | CA
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Zip | 91801-5103
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Country | US
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Telephone | 626-497-3883
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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 | A99479
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD25291
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License Number State | OR
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