Provider Demographics
NPI:1295829562
Name:WONG, EDWARD K JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:WONG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:22941 TRITON WAY
Mailing Address - Street 2:127
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1238
Mailing Address - Country:US
Mailing Address - Phone:949-215-9200
Mailing Address - Fax:
Practice Address - Street 1:22941 TRITON WAY
Practice Address - Street 2:127
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1238
Practice Address - Country:US
Practice Address - Phone:949-215-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000000G19891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG19891CMedicare PIN
CAWG19891BMedicare PIN