Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G41626 | CA |
NPI | 1013924448 |
---|---|
Provider Name | Dr. Hubert K Wong |
First Address | Concord, CA 94520-2051 |
Second Address | Oakland, CA 94609-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G416260 | (05) | CA |
A48637 | (02) | CA |