MEDICARE: JOHN LAI AND KEVIN WONG MEDICAL CORPORATION

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	G79696	CA

General Provider Information

NPI Number	:	1528126364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN LAI AND KEVIN WONG MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1500 SOUTHGATE AVE STE 115
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2205
Country	:	US
Telephone Number	:	650-991-4466
Fax Number	:	650-991-4467

Provider Business Practice Location Address
First Line	:	1500 SOUTHGATE AVE STE 115
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2205
Country	:	US
Telephone Number	:	650-991-4466
Fax Number	:	650-991-4467

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. KEVIN MINGYIU WONG
Credential	:	M.D.
Telephone Number	:	650-991-4466

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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