Provider Demographics
NPI:1871512301
Name:WONG, CLIFFORD CHEW (MD)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:CHEW
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 1:950 STOCKTON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1619
Mailing Address - Country:US
Mailing Address - Phone:415-398-4538
Mailing Address - Fax:415-398-8286
Practice Address - Street 1:950 STOCKTON ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1619
Practice Address - Country:US
Practice Address - Phone:415-398-4538
Practice Address - Fax:415-398-8286
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304430Medicaid
CA00G304430Medicare ID - Type Unspecified
CA00G304430Medicaid