Provider Demographics
NPI:1346681517
Name:WONG, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:KE JIE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST FL 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3400
Practice Address - Fax:916-733-5384
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18680208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist