Provider Demographics
NPI:1396917936
Name:WONG, PAULINE PHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:PHAM
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 27250
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809-0297
Mailing Address - Country:US
Mailing Address - Phone:951-270-0211
Mailing Address - Fax:951-270-0702
Practice Address - Street 1:3811 BEDFORD CANYON RD STE 105
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0789
Practice Address - Country:US
Practice Address - Phone:951-270-0211
Practice Address - Fax:951-270-0702
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist