Provider Demographics
NPI:1376962381
Name:WONG, KARLTON (MD)
Entity Type:Individual
Prefix:
First Name:KARLTON
Middle Name:
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 1:181 S BUENA VISTA ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4504
Mailing Address - Country:US
Mailing Address - Phone:818-840-0921
Mailing Address - Fax:818-840-7064
Practice Address - Street 1:181 S BUENA VISTA ST FL 4
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-840-0921
Practice Address - Fax:818-840-7064
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139400207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAKW3232267556Medicaid