MEDICARE: TSUNG PETER WONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A60539	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073513156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSUNG PETER WONG MD

Provider Business Mailing Address
First Line	:	87 FENTON ST STE 210
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4159
Country	:	US
Telephone Number	:	925-371-8885
Fax Number	:	925-371-8884

Provider Business Practice Location Address
First Line	:	87 FENTON ST STE 210
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4159
Country	:	US
Telephone Number	:	925-371-8885
Fax Number	:	925-371-8884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/15/2020

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