Provider Demographics
NPI:1073513156
Name:WONG, TSUNG PETER (MD)
Entity Type:Individual
Prefix:
First Name:TSUNG
Middle Name:PETER
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 FENTON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4159
Mailing Address - Country:US
Mailing Address - Phone:925-371-8885
Mailing Address - Fax:925-371-8884
Practice Address - Street 1:87 FENTON ST STE 210
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4159
Practice Address - Country:US
Practice Address - Phone:925-371-8885
Practice Address - Fax:925-371-8884
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A605390Medicaid
F69268Medicare UPIN
CA00A605390Medicare ID - Type Unspecified
CAAT423YMedicare PIN
CA00A605390Medicaid