Provider Demographics
NPI:1710117932
Name:WONG, KELVIN S (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:S
Last Name:WONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:866-220-7329
Mailing Address - Fax:615-261-6806
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-973-5902
Practice Address - Fax:805-973-5905
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2015-10-02
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Provider Licenses
StateLicense IDTaxonomies
CAA128942208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology