Provider Demographics
NPI:1154403624
Name:WONG, DANIEL K
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:KAMBOR
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13939 SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4036
Mailing Address - Country:US
Mailing Address - Phone:562-868-6888
Mailing Address - Fax:562-868-6888
Practice Address - Street 1:13939 SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4036
Practice Address - Country:US
Practice Address - Phone:562-868-6888
Practice Address - Fax:562-868-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine