Provider Demographics
NPI:1376655431
Name:WONG, HENRY YICK TUNG (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:YICK TUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10515 ESCONDIDO PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9267
Mailing Address - Country:US
Mailing Address - Phone:209-931-9537
Mailing Address - Fax:209-931-8277
Practice Address - Street 1:1800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6019
Practice Address - Country:US
Practice Address - Phone:209-467-6335
Practice Address - Fax:209-461-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA261992085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87010Medicare UPIN