Provider Demographics
NPI:1700950599
Name:WONG, KAI WAI (MD)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:WAI
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 1:2323 16TH ST
Mailing Address - Street 2:#501
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3420
Mailing Address - Country:US
Mailing Address - Phone:661-327-4484
Mailing Address - Fax:661-327-7077
Practice Address - Street 1:2323 16TH ST
Practice Address - Street 2:#501
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3420
Practice Address - Country:US
Practice Address - Phone:661-327-4484
Practice Address - Fax:661-327-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G644030Medicare ID - Type Unspecified
E78682Medicare UPIN