Provider Demographics
NPI:1215953211
Name:WONG, DONNA LYNN (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:WONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10800 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3331
Mailing Address - Country:US
Mailing Address - Phone:562-923-8333
Mailing Address - Fax:562-862-1624
Practice Address - Street 1:10800 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3331
Practice Address - Country:US
Practice Address - Phone:562-923-8333
Practice Address - Fax:562-862-1624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX6755AMedicaid
CA00AX6755AMedicaid
CAG44804Medicare UPIN