Provider Demographics
NPI:1548312283
Name:WONG, ALAN S (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:SHUI LUN
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1418 ROYAL ANN CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4776
Mailing Address - Country:US
Mailing Address - Phone:408-257-7528
Mailing Address - Fax:408-996-7380
Practice Address - Street 1:18988 COX AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4154
Practice Address - Country:US
Practice Address - Phone:408-996-7336
Practice Address - Fax:408-996-7380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58670OtherMEDICAL LICENSE NUMBER
BW7419965OtherDEA NUMBER
BW7419965OtherDEA NUMBER
00G586701Medicare ID - Type Unspecified