1285144675 NPI number — EUGENE W WONG MD A MEDICAL CORPORATION

Table of content: (NPI 1285144675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285144675 NPI number — EUGENE W WONG MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUGENE W WONG MD A MEDICAL CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1285144675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92863-5486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-550-0900
Provider Business Mailing Address Fax Number:
303-953-8260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44301 LORIMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-940-1112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-709-8232

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  A124915 , 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)





Copyright © 2007-2025 www.npivalidator.com