Basic Information
| Provider Information | |||||||||
| NPI: | 1487779047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | PUI OI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2673 SUN DR | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932301331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595841401 | ||||||||
| FaxNumber: | 5595890482 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 N DOUTY ST | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595370224 | ||||||||
| FaxNumber: | 5595832120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 04/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | G33575 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 2083P0901X | G33575 | CA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 208D00000X | G33575 | CA | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | G33575 | 01 | CA | MEDICAL LICENSE | OTHER |