Basic Information
| Provider Information | |||||||||
| NPI: | 1821348392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES D WONG DO MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2287 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933032287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613240300 | ||||||||
| FaxNumber: | 6613244095 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 STOCKDALE HWY | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933113620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616636550 | ||||||||
| FaxNumber: | 6616636259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6613240300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 20A8787 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.