Provider Demographics
NPI:1598228157
Name:WONG, JASON H (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:H
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-3300
Mailing Address - Country:US
Mailing Address - Phone:619-881-9169
Mailing Address - Fax:619-532-9134
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3300
Practice Address - Country:US
Practice Address - Phone:619-881-9169
Practice Address - Fax:619-532-9134
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270185207R00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine