Provider Demographics
NPI:1831219344
Name:WONG, HARLAND (OPAC)
Entity type:Individual
Prefix:MR
First Name:HARLAND
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:OPAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:SUITE 310 B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-297-2833
Mailing Address - Fax:408-271-4908
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 310 B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-297-2833
Practice Address - Fax:408-271-4908
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL199363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical