Provider Demographics
NPI:1376737304
Name:NAOMI J. WONG, D.D.S.
Entity Type:Organization
Organization Name:NAOMI J. WONG, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-223-2021
Mailing Address - Street 1:415 W CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5905
Mailing Address - Country:US
Mailing Address - Phone:714-223-2021
Mailing Address - Fax:714-223-2021
Practice Address - Street 1:415 W CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5905
Practice Address - Country:US
Practice Address - Phone:714-223-2021
Practice Address - Fax:714-223-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37183261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90548-02Medicaid