Provider Demographics
NPI:1073900163
Name:WONG, MORGAN (DO)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2331 MONTPELIER DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1673
Mailing Address - Country:US
Mailing Address - Phone:408-515-2428
Mailing Address - Fax:408-347-9004
Practice Address - Street 1:2331 MONTPELIER DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1673
Practice Address - Country:US
Practice Address - Phone:408-515-2428
Practice Address - Fax:408-347-9004
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2504-21207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology