Provider Demographics
NPI:1396702684
Name:WONG, CEDRIC LOH-SHIN (MD)
Entity type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:LOH-SHIN
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 PLAZA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4782
Mailing Address - Country:US
Mailing Address - Phone:916-260-9237
Mailing Address - Fax:916-221-7783
Practice Address - Street 1:530 PLAZA DR STE 110
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4782
Practice Address - Country:US
Practice Address - Phone:916-260-9237
Practice Address - Fax:916-221-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74697174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH95395Medicare UPIN