Provider Demographics
NPI:1316014392
Name:WONG, WILLIAM K (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KONG
Other - Middle Name:D
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15203 11TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:VICTOVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3737
Mailing Address - Country:US
Mailing Address - Phone:760-245-6691
Mailing Address - Fax:760-245-2671
Practice Address - Street 1:15203 11TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:VICTOVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3737
Practice Address - Country:US
Practice Address - Phone:760-245-6691
Practice Address - Fax:760-245-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316440Medicaid
CA00A316440Medicare ID - Type Unspecified
CA00A316440Medicaid