Provider Demographics
NPI:1912935347
Name:WONG, NGA WAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:NGA
Middle Name:WAN
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NGA
Other - Middle Name:WAN
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6181 GLENEAGLES CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-960-8245
Mailing Address - Fax:714-960-8295
Practice Address - Street 1:6552 BOLSA AVE
Practice Address - Street 2:SUITE N
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2656
Practice Address - Country:US
Practice Address - Phone:714-898-9635
Practice Address - Fax:714-898-9637
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002451Medicaid
CAW6594Medicare PIN
CAE01583Medicare UPIN