Provider Demographics
NPI:1568443307
Name:WONG, ALVIN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:DAVID
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA
Mailing Address - Street 2:310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-387-1534
Mailing Address - Fax:415-387-8750
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-387-1534
Practice Address - Fax:415-387-8750
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G609450Medicaid
CA197120100OtherDEPT OF LABOR
CA110089947OtherRAILROAD MEDICARE
CA197120100OtherDEPT OF LABOR
CA00G609450Medicaid