Provider Demographics
NPI:1356315865
Name:WONG, DOROTHY LAI PING (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:LAI PING
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD22877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860917930OtherTID
AZMD22877OtherSTATE LICENCE
AZ110180845OtherRR MEDICARE
AZ330085Medicaid
AZAZ0805637OtherBCBS AZ
AZ860917930OtherTID
AZ29260Medicare ID - Type Unspecified