Provider Demographics
NPI:1497805600
Name:WONG, WESLEY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2158
Mailing Address - Country:US
Mailing Address - Phone:714-282-9794
Mailing Address - Fax:714-282-9794
Practice Address - Street 1:501 STUDENT HEALTH
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-5200
Practice Address - Country:US
Practice Address - Phone:949-824-9465
Practice Address - Fax:949-824-3033
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice