Provider Demographics
NPI:1669558821
Name:WONG, HUNG-KWONG (MD)
Entity type:Individual
Prefix:
First Name:HUNG-KWONG
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 S DE ANZA BLVD STE 230B
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3019
Mailing Address - Country:US
Mailing Address - Phone:408-295-1886
Mailing Address - Fax:408-295-2207
Practice Address - Street 1:10430 S DE ANZA BLVD STE 230B
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3019
Practice Address - Country:US
Practice Address - Phone:408-295-1886
Practice Address - Fax:408-295-2207
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539690Medicaid
CAA53969OtherSTATE LICENSE
00A539690Medicare ID - Type Unspecified
CAA53969OtherSTATE LICENSE