Provider Demographics
NPI:1053500595
Name:FRANK FOOK Y. WONG, MD, INC.
Entity Type:Organization
Organization Name:FRANK FOOK Y. WONG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF INC.
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:FOOK Y
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-6566
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:# 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-258-6566
Mailing Address - Fax:408-258-6660
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:# 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-258-6566
Practice Address - Fax:408-258-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66621OtherCALIFORNIA M.D. LICENCE #
CAZZZ26797ZOtherMEDICARE GROUP
CAG66621OtherCALIFORNIA M.D. LICENCE #