Provider Demographics
NPI:1184649220
Name:WONG, RONALD N (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:N
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 1:355 CAMPUS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4310
Mailing Address - Country:US
Mailing Address - Phone:559-584-6684
Mailing Address - Fax:559-584-6686
Practice Address - Street 1:355 CAMPUS DR
Practice Address - Street 2:SUITE B
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4310
Practice Address - Country:US
Practice Address - Phone:559-584-6684
Practice Address - Fax:559-584-6686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG342270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G342270Medicaid
CA00G342270Medicaid
CA00G342270Medicare ID - Type Unspecified