Provider Demographics
NPI:1902002231
Name:WONG, DANIEL (ENDOCRINOLOGY)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:ENDOCRINOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 29TH STREET
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5173
Mailing Address - Country:US
Mailing Address - Phone:916-455-3700
Mailing Address - Fax:916-733-8232
Practice Address - Street 1:1020 29TH STREET
Practice Address - Street 2:SUITE 270
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5173
Practice Address - Country:US
Practice Address - Phone:916-455-3700
Practice Address - Fax:916-733-8232
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS20070390207R00000X
CAA120861207RE0101X
FLTRN15216207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine