Provider Demographics
NPI:1992168884
Name:WONG, JESSALYN LIANNE GARLING (DO)
Entity type:Individual
Prefix:
First Name:JESSALYN
Middle Name:LIANNE GARLING
Last Name:WONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5905
Mailing Address - Country:US
Mailing Address - Phone:213-537-7259
Mailing Address - Fax:
Practice Address - Street 1:415 W CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5905
Practice Address - Country:US
Practice Address - Phone:213-537-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18573207QS1201X
INCV2102535208M00000X
CA18573208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine