Provider Demographics
NPI:1528357175
Name:WONG, HAROLD (PA-C)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23823 VALENCIA BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-9512
Mailing Address - Country:US
Mailing Address - Phone:661-254-0026
Mailing Address - Fax:
Practice Address - Street 1:23823 VALENCIA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-9512
Practice Address - Country:US
Practice Address - Phone:661-254-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant