Provider Demographics
NPI:1063442879
Name:WONG, JOE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1714 COLINA TERRESTRE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3651
Mailing Address - Country:US
Mailing Address - Phone:949-973-5448
Mailing Address - Fax:949-493-7348
Practice Address - Street 1:31852 COAST HWY STE 201
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6765
Practice Address - Country:US
Practice Address - Phone:949-715-0505
Practice Address - Fax:949-715-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG34262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG34262AMedicare PIN
CAA91575Medicare UPIN