Provider Demographics
NPI:1902237068
Name:RODNEY Z. WONG, M.D., INC.
Entity Type:Organization
Organization Name:RODNEY Z. WONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-967-7249
Mailing Address - Street 1:515 SOUTH DR
Mailing Address - Street 2:#16
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4204
Mailing Address - Country:US
Mailing Address - Phone:650-967-7249
Mailing Address - Fax:650-967-7350
Practice Address - Street 1:515 SOUTH DR
Practice Address - Street 2:#16
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4204
Practice Address - Country:US
Practice Address - Phone:650-967-7249
Practice Address - Fax:650-967-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56838207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53197Medicare UPIN