Provider Demographics
NPI:1518526821
Name:WONG, ERNEST H (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:H
Last Name:WONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 WESTWOOD DR STE J
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5111
Mailing Address - Country:US
Mailing Address - Phone:408-826-4676
Mailing Address - Fax:
Practice Address - Street 1:4138 DYER ST STE 2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3975
Practice Address - Country:US
Practice Address - Phone:510-487-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065111223G0001X, 1223G0001X
FL242651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice