Provider Demographics
NPI:1396705356
Name:WONG, CHING YEE (MD)
Entity type:Individual
Prefix:
First Name:CHING
Middle Name:YEE
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHING-YEE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1500 EXPO PKWY
Mailing Address - Street 2:SUTTER HEALTH IMAGING
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:248-701-8979
Mailing Address - Fax:
Practice Address - Street 1:1500 EXPO PKWY
Practice Address - Street 2:SUTTER HEALTH IMAGING
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4227
Practice Address - Country:US
Practice Address - Phone:248-701-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073055207U00000X
CAC144795207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3521647Medicaid
MI010F362410OtherBCBSM
MI010F362410OtherBCBSM
MI3521647Medicaid