Provider Demographics
NPI:1528120904
Name:WONG, FOOK Y (MD)
Entity type:Individual
Prefix:
First Name:FOOK
Middle Name:Y
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:FOOK Y
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-258-6566
Mailing Address - Fax:408-258-6660
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-258-6566
Practice Address - Fax:408-258-6660
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66621207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66621OtherCAL MD LICENSE #
CAH92727Medicare UPIN
CAZZZ26797ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #