Provider Demographics
NPI:1447586904
Name:WONG, JARED SZE WEI (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:SZE WEI
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 1:4950 SAN BERNARDINO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:909-621-7647
Mailing Address - Fax:877-887-5774
Practice Address - Street 1:4950 SAN BERNARDINO ST STE 202
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-621-7647
Practice Address - Fax:877-887-5774
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137345208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery