Provider Demographics
NPI:1992091623
Name:WONG, TIMOTHY PHILIP (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PHILIP
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE # 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25455 BARTON RD
Practice Address - Street 2:SUITE 204B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3128
Practice Address - Country:US
Practice Address - Phone:909-558-6526
Practice Address - Fax:909-558-6033
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12729207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine