Provider Demographics
NPI:1053408435
Name:WONG, ING L (MD)
Entity type:Individual
Prefix:DR
First Name:ING
Middle Name:L
Last Name:WONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-594-6995
Mailing Address - Fax:562-594-4488
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:STE 225
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-594-6995
Practice Address - Fax:562-594-4488
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24840207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00248400Medicaid
CA00248400Medicaid
CAWA24840AMedicare ID - Type Unspecified