Basic Information
| Provider Information | |||||||||
| NPI: | 1619634839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | VINGQUI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4719 QUAIL LAKES DR # G425 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952075267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093736431 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 DELBON AVE | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953822016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096642790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2021 | ||||||||
| LastUpdateDate: | 01/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 60451 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.