Dr. Granger Bradford Wong
Surgeon Medical Geneticist
2221 Stockton Blvd
Sacramento
, California 95817-1418
Dr. Granger Bradford Wong
Surgeon Medical Geneticist
2221 Stockton Blvd
Sacramento
, California 95817-1418
(916) 734-2130
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About
Features
Specialties
- Medical Geneticist
- Surgeon
Languages spoken
- English
Location
First Address
- Dr. Granger Bradford Wong
- 2221 Stockton Blvd
- Sacramento, CA
- Zip : 95817-1418
- Phone : (916) 734-2130
Second Address
- Dr. Granger Bradford Wong
- 2221 Stockton Blvd
- Sacramento, CA
- Zip : 95817-1418
- Phone : (916) 734-2130
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 170100000X | Medical Geneticist | A54333 | CA |
| Y | 208200000X | Surgeon | A54333 | CA |
| Y | 208600000X | Surgeon | A54333 | CA |
National Provider Identifier
| NPI | 1225013790 |
|---|---|
| Provider Name | Dr. Granger Bradford Wong |
| First Address | Sacramento, CA 95817-1418 |
| Second Address | Sacramento, CA 95817-1418 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/12/2005 |
| Last Update Date | 10/03/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| F79631 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.