Basic Information
| Provider Information | |||||||||
| NPI: | 1235172446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15400 NATIONAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950322433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083588400 | ||||||||
| FaxNumber: | 4083582793 | ||||||||
| Practice Location | |||||||||
| Address1: | 15400 NATIONAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950322433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083588400 | ||||||||
| FaxNumber: | 4083582793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 48162 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | A102501 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.