Provider Demographics
NPI:1083825624
Name:WONG, TIN-CHEU (MD)
Entity Type:Individual
Prefix:DR
First Name:TIN-CHEU
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:T C
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:420 N GARFIELD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1206
Mailing Address - Country:US
Mailing Address - Phone:626-572-3937
Mailing Address - Fax:626-571-8819
Practice Address - Street 1:420 N GARFIELD AVE STE 208
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1206
Practice Address - Country:US
Practice Address - Phone:626-572-3937
Practice Address - Fax:626-571-8819
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56514207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G565140Medicaid
CAW11121Medicare PIN
CA00G565140Medicaid