MEDICARE: ALICE 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	G48943	CA

General Provider Information

NPI Number	:	1295801546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE WONG MD

Provider Business Mailing Address
First Line	:	501 STUDENT HEALTH
Second Line	:	UNIVERSITY OF CALIFORNIA-IRVINE
City	:	IRVINE
State	:	CA
Zip	:	92697-5200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 STUDENT HEALTH
Second Line	:	UNIVERSITY OF CALIFORNIA-IRVINE
City	:	IRVINE
State	:	CA
Zip	:	92697-5200
Country	:	US
Telephone Number	:	949-824-7010
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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