Provider Demographics
NPI:1538101506
Name:WONG, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:# 59
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2304
Mailing Address - Country:US
Mailing Address - Phone:310-271-4407
Mailing Address - Fax:323-936-6927
Practice Address - Street 1:8306 WILSHIRE BLVD
Practice Address - Street 2:#501
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2382
Practice Address - Country:US
Practice Address - Phone:310-271-4407
Practice Address - Fax:323-936-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA230112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A230110Medicaid
CA757263071OtherRAILROAD MEDICARE
CA00A230110Medicaid
CA757263071OtherRAILROAD MEDICARE