MEDICARE: DR. EDWARD K WONG JR. 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	207W00000X	Ophthalmology Physician	000000G19891	CA

General Provider Information

NPI Number	:	1295829562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD K WONG JR. MD

Provider Business Mailing Address
First Line	:	22941 TRITON WAY
Second Line	:	127
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1238
Country	:	US
Telephone Number	:	949-215-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	22941 TRITON WAY
Second Line	:	127
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1238
Country	:	US
Telephone Number	:	949-215-9200
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/30/2012

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