MEDICARE: DR. SAMMY SUM 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	207R00000X	Internal Medicine Physician	G63948	CA

General Provider Information

NPI Number	:	1265535124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMMY SUM WONG MD

Provider Business Mailing Address
First Line	:	1357 W CLIFTON AVE
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5659
Country	:	US
Telephone Number	:	909-557-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1357 W CLIFTON AVE
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5659
Country	:	US
Telephone Number	:	909-557-3049
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/10/2026

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