Provider Demographics
NPI:1427001775
Name:WONG, LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17150 NEWHOPE ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4250
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:10760 WARNER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3845
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG45605207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45605OtherSTATE LICENSE