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General NPI Number Information
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NPI Number | 1760499123
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Entity Type | Individual
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Provider Name | WILL M WONG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 4980 BARRANCA PKWY SUITE 150
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City | IRVINE
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State | CA
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Zip | 92604-8645
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Country | US
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Telephone | 949-551-0661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15013
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City | IRVINE
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State | CA
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Zip | 92623-5013
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Country | US
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Telephone | 949-551-0661
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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 | 38383
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License Number State | CA
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