Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 20A8787 | CA |
N | 208200000X | Surgeon | 20A8787 | CA |
N | 208600000X | Surgeon | 20A8787 | CA |
NPI | 1255508131 |
---|---|
Provider Name | Dr. Charles David Wong |
First Address | Bakersfield, CA 93303-2287 |
Second Address | Bakersfield, CA 93311-9506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2008 |
Last Update Date | 14/10/2021 |