Provider Demographics
NPI:1962516245
Name:WONG, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE E-420
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:760-322-5033
Mailing Address - Fax:760-320-1565
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE E-420
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-322-5033
Practice Address - Fax:760-320-1565
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG085258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH25429Medicare UPIN