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General NPI Number Information
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NPI Number | 1912191404
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Entity Type | Organization
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Legal Business Name | DOROTHY L. P. WONG, MD, LLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 1025 W 24TH ST SUITE 26
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City | YUMA
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State | AZ
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Zip | 85364-8366
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Country | US
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Telephone | 928-344-5455
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Fax | 928-344-5465
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Provider Business Mailing Address
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Address Line | 1025 W 24TH ST SUITE 26
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City | YUMA
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State | AZ
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Zip | 85364-8366
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Country | US
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Telephone | 928-344-5455
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Fax | 928-344-5465
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOROTHY LAI PING WONG
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Credential | M.D.
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Telephone | 928-344-5455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 22877
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License Number State | AZ
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