Provider Demographics
NPI:1386674471
Name:WONG, ERVIN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:PATRICK
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:728 PACIFIC AVE
Mailing Address - Street 2:506
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4457
Mailing Address - Country:US
Mailing Address - Phone:415-837-0861
Mailing Address - Fax:415-986-1932
Practice Address - Street 1:728 PACIFIC AVE
Practice Address - Street 2:506
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4457
Practice Address - Country:US
Practice Address - Phone:415-837-0861
Practice Address - Fax:415-986-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYA811700174400000X
CAA81170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76483Medicare UPIN