Provider Demographics
NPI:1780621706
Name:WONG, CLIFFORD (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLIFFORD
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27200 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4339
Mailing Address - Country:US
Mailing Address - Phone:510-783-2003
Mailing Address - Fax:510-783-2007
Practice Address - Street 1:27200 CALAROGA AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4339
Practice Address - Country:US
Practice Address - Phone:510-783-2003
Practice Address - Fax:510-783-2007
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68265207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A682650Medicaid
CAH73554Medicare UPIN
CA00A682652Medicare ID - Type Unspecified