Provider Demographics
NPI:1073560249
Name:WONG, RIDGLEY F (MD)
Entity Type:Individual
Prefix:MR
First Name:RIDGLEY
Middle Name:F
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5530 BIRDCAGE STREET
Mailing Address - Street 2:STE 145
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:916-851-2884
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67149207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G671490OtherBS OF CA
CA00G671490Medicaid
CA00G671490OtherBS OF CA
CA050021768Medicare PIN
F41757Medicare UPIN
CA00G671492Medicare PIN
CA00G671490Medicaid
CA050020036Medicare PIN