Provider Demographics
NPI:1851339865
Name:JON WONG M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JON WONG M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-4407
Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:#501
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:310-271-4407
Mailing Address - Fax:909-902-6621
Practice Address - Street 1:1329 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 128
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2824
Practice Address - Country:US
Practice Address - Phone:805-494-8430
Practice Address - Fax:805-494-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty