MEDICARE: DR. DOUGLAS S WONG M.D.

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	174400000X	Specialist	G45487	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	:	1699778399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS S WONG M.D.

Provider Business Mailing Address
First Line	:	1303 E HERNDON AVE
Second Line	:	SUITE 431
City	:	FRESNO
State	:	CA
Zip	:	93720-3309
Country	:	US
Telephone Number	:	559-450-3889
Fax Number	:	559-450-7473

Provider Business Practice Location Address
First Line	:	7130 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3347
Country	:	US
Telephone Number	:	559-450-5500
Fax Number	:	559-450-7473

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/20/2015

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