Provider Demographics
NPI:1902805294
Name:WONG, CALBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:CALBERT
Middle Name:A
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4000 CALLE TECATE STE 115
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5285
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-233-3025
Practice Address - Street 1:2438 N PONDEROSA DR
Practice Address - Street 2:# C-101
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2369
Practice Address - Country:US
Practice Address - Phone:805-383-9727
Practice Address - Fax:805-764-0176
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52812207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528120Medicaid
CA00A528120Medicaid
CACB215239Medicare PIN