Provider Demographics
NPI:1477553444
Name:WONG, BILL NAM (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:NAM
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:5575 W LAS POSITAS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5800
Mailing Address - Country:US
Mailing Address - Phone:925-463-0590
Mailing Address - Fax:925-847-9532
Practice Address - Street 1:5575 W LAS POSITAS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5800
Practice Address - Country:US
Practice Address - Phone:925-463-0590
Practice Address - Fax:925-847-9532
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48992207R00000X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G489920Medicaid
CA00G489920Medicaid
CA00G489920Medicare ID - Type Unspecified