Provider Demographics
NPI:1275553307
Name:WONG, STEVEN GENE WEI (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GENE WEI
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 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4001
Mailing Address - Country:US
Mailing Address - Phone:310-824-4133
Mailing Address - Fax:310-208-1584
Practice Address - Street 1:2811 WILSHIRE BLVD STE 414
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4804
Practice Address - Country:US
Practice Address - Phone:310-552-9999
Practice Address - Fax:310-201-6685
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD23655207RH0003X
CAG79910207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G799100Medicaid
AK210540OtherLICENSE
CA00G799100Medicaid
CAGR963ZMedicare PIN