Provider Demographics
NPI:1508131129
Name:DONNA L. WONG, DO, INC.
Entity Type:Organization
Organization Name:DONNA L. WONG, DO, INC.
Other - Org Name:DONNA L. WONG, DO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-923-8333
Mailing Address - Street 1:10800 PARAMOUNT BLVD.
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3334
Mailing Address - Country:US
Mailing Address - Phone:562-923-8333
Mailing Address - Fax:562-923-2433
Practice Address - Street 1:10800 PARAMOUNT BLVD.
Practice Address - Street 2:SUITE 402
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3334
Practice Address - Country:US
Practice Address - Phone:562-923-8333
Practice Address - Fax:562-923-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6755207Q00000X
CA20A6755A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX6755AMedicaid
CA00AX6755AMedicaid