Provider Demographics
NPI:1376656967
Name:WONG, KAI Y (MD)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:Y
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W DUARTE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9253
Mailing Address - Country:US
Mailing Address - Phone:626-898-4801
Mailing Address - Fax:626-898-4802
Practice Address - Street 1:624 W DUARTE RD
Practice Address - Street 2:STE 104
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9253
Practice Address - Country:US
Practice Address - Phone:626-898-4801
Practice Address - Fax:626-898-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534471Medicaid
CA00A534471Medicaid
CAG01018Medicare UPIN