Provider Demographics
NPI:1235299538
Name:I. LANE WONG, M.D. INC.
Entity Type:Organization
Organization Name:I. LANE WONG, M.D. INC.
Other - Org Name:HOPE FERTILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-387-3888
Mailing Address - Street 1:2500 ALTON PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5034
Mailing Address - Country:US
Mailing Address - Phone:949-387-3888
Mailing Address - Fax:949-387-3907
Practice Address - Street 1:2500 ALTON PKWY STE 201
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5034
Practice Address - Country:US
Practice Address - Phone:949-387-3888
Practice Address - Fax:949-387-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59317207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G59317OtherBLUE SHIELD ID
CAG59317OtherMEDICAL LICENSE NUMBER
CAINF1012OtherMONARCH HEALTHCARE ID