Provider Demographics
NPI:1134204043
Name:WONG, SUNNY WING CHI (DO)
Entity type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:WING CHI
Last Name:WONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 W EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1718
Mailing Address - Country:US
Mailing Address - Phone:626-307-0676
Mailing Address - Fax:626-307-0666
Practice Address - Street 1:110 W EMERSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1718
Practice Address - Country:US
Practice Address - Phone:626-307-0676
Practice Address - Fax:626-307-0666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH96898Medicare UPIN