Provider Demographics
NPI:1447226634
Name:WONG, VICTOR CHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:CHAN
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 1:1470 BELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2713
Mailing Address - Country:US
Mailing Address - Phone:310-384-5869
Mailing Address - Fax:
Practice Address - Street 1:199 S LOS ROBLES AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2452
Practice Address - Country:US
Practice Address - Phone:626-817-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine