Basic Information
| Provider Information | |||||||||
| NPI: | 1730240912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | CHUNG-YUN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 N ANN ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930012111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3291 LOMA VISTA RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930033099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | G766180 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.