1144524232 NPI number — CURTIS SF WONG, MD, INC

Table of content: (NPI 1144524232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144524232 NPI number — CURTIS SF WONG, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS SF WONG, MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORCAL AESTHETIC PLASTIC SURGERY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144524232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 SISTER MARY COLUMBA DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RED BLUFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96080-4356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-690-2424
Provider Business Mailing Address Fax Number:
530-690-2426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 SISTER MARY COLUMBA DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-690-2424
Provider Business Practice Location Address Fax Number:
530-690-2426
Provider Enumeration Date:
01/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
SF
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-690-2424

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  G74386 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G743860 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G743860 . This is a "MEDICARE ID - UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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