Provider Demographics
NPI:1912191404
Name:DOROTHY L. P. WONG, MD, LLC
Entity Type:Organization
Organization Name:DOROTHY L. P. WONG, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LAI PING
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-5455
Mailing Address - Street 1:1025 W 24TH ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8366
Mailing Address - Country:US
Mailing Address - Phone:928-344-5455
Mailing Address - Fax:928-344-5465
Practice Address - Street 1:1025 W 24TH ST
Practice Address - Street 2:SUITE 26
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8366
Practice Address - Country:US
Practice Address - Phone:928-344-5455
Practice Address - Fax:928-344-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22877207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110180845OtherRAILROAD MEDICARE
AZ330085Medicaid
AZ330085Medicaid
AZG21207Medicare UPIN