Provider Demographics
NPI:1861417206
Name:WING, RONALD H (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:H
Last Name:WING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W. MAGNOLIA BLVD.,
Mailing Address - Street 2:#120
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1753
Mailing Address - Country:US
Mailing Address - Phone:818-955-5773
Mailing Address - Fax:818-955-5181
Practice Address - Street 1:2211 WEST MAGNOLIA BLVD
Practice Address - Street 2:#120
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1753
Practice Address - Country:US
Practice Address - Phone:818-955-5773
Practice Address - Fax:818-955-5181
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248260Medicaid
CA00A248260Medicaid
CAA24826Medicare ID - Type Unspecified