Provider Demographics
NPI:1285733063
Name:WONG, ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6301 S MCCLINTOCK DR
Mailing Address - Street 2:#101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3392
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:60 S KYRENE RD
Practice Address - Street 2:STE. 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4685
Practice Address - Country:US
Practice Address - Phone:480-785-8700
Practice Address - Fax:480-758-8787
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1409550OtherDES
AZ0867990OtherBLUE CROSS BLUE SHIELD
00014257OtherBANNER HEALTH PLAN
AZ140955OtherAHCCCS
1Z6560OtherHEALTHNET
140955001OtherAPIPA