Provider Demographics
NPI:1194134056
Name:WONG, DOUGLAS K C (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:K C
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 VILLAGE PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2453
Mailing Address - Country:US
Mailing Address - Phone:925-828-4041
Mailing Address - Fax:925-828-7837
Practice Address - Street 1:7033 VILLAGE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2453
Practice Address - Country:US
Practice Address - Phone:925-828-4041
Practice Address - Fax:925-828-7837
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34796122300000X
HI1483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist