Doctor Name: | DR. GORDON K WONG |
NPI Number: | 1639345184 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D., PH.D., M.P.H. |
License Number: | A71751 |
Business Practice Address: | 409 W Main St Alhambra, CA - 918013433 |
Business Phone Number: | 6263821263 |
Business Fax Number: | 6263821252 |
Mailing Address: | 409 W Main St, ALHAMBRA |
State: | CA |
Postal Code: | 918013433 |
Phone Number: | 6263821263 |
Fax Number: | 6263821252 |
NPI Enumeration Date: | 05/05/2008 |
NPI Last Update Date: | 03/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A71751 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |