| Organization Name: | STANISLAUS CARDIOLOGY GROUP |
| NPI Number: | 1902828841 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENT HON-WAH WONG (PARTNER) |
| Mailing Address: | 3621 Forest Glenn Dr Modesto |
| State: | CA US |
| Postal Code: | 953551339 |
| Phone Number: | 2095219661 |
| Fax Number: | 2095219307 |
| NPI Enumeration Date: | 07/23/2006 |
| NPI Last Update Date: | 04/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | FNP 30072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |