MEDICARE: MRS. NGA WAN 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	207R00000X	Internal Medicine Physician	A26311	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	:	1912935347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NGA WAN WONG M.D.

Provider Business Mailing Address
First Line	:	6181 GLENEAGLES CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648
Country	:	US
Telephone Number	:	714-960-8245
Fax Number	:	714-960-8295

Provider Business Practice Location Address
First Line	:	6552 BOLSA AVE
Second Line	:	SUITE N
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2656
Country	:	US
Telephone Number	:	714-898-9635
Fax Number	:	714-898-9637

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	02/26/2009

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