Provider Demographics
NPI:1366691099
Name:WONG, VINCENT K W (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:K W
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110150122085R0202X
CAA1199912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOGH828GMedicare PIN
CAGH828JMedicare PIN
CAGH828MMedicare PIN
CAGH828WMedicare PIN
CAGH828EMedicare PIN
CAGH828IMedicare PIN
CAGH828LMedicare PIN
CAGH828PMedicare PIN
CAGH828SMedicare PIN
CAGH828QMedicare PIN
CAGH828VMedicare PIN
CAGH828XMedicare PIN
CAGH828OMedicare PIN
CAGH828RMedicare PIN
CAGH828UMedicare PIN
MNGH828YMedicare PIN
CAGH828NMedicare PIN
CAGH828KMedicare PIN
CAGH828TMedicare PIN
CAGH828ZMedicare PIN
CAGH828HMedicare PIN
CAGH828FMedicare PIN