MEDICARE: DR. GORDON ALVIN 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	A22027	CA

General Provider Information

NPI Number	:	1811072861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON ALVIN WONG M.D.

Provider Business Mailing Address
First Line	:	3941 J ST
Second Line	:	SUITE 354
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3624
Country	:	US
Telephone Number	:	916-733-6870
Fax Number	:	916-454-0490

Provider Business Practice Location Address
First Line	:	3941 J ST
Second Line	:	SUITE 354
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3624
Country	:	US
Telephone Number	:	916-733-6870
Fax Number	:	916-454-0490

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/26/2017

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