Provider Demographics
NPI:1740237163
Name:WONG, ALAN KONG (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KONG
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:107 MARGARET LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5211
Mailing Address - Country:US
Mailing Address - Phone:530-274-9623
Mailing Address - Fax:530-274-0590
Practice Address - Street 1:107 MARGARET LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5211
Practice Address - Country:US
Practice Address - Phone:530-274-9623
Practice Address - Fax:530-274-0590
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50541208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505411Medicaid
CAZZZ20196ZMedicare ID - Type Unspecified
CA00A505411Medicaid