Individual
I LANE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 ALTON PKWY, STE. 201, IRVINE, CA 92606-5024
(949) 387-3888
(949) 387-3907
Mailing address
2500 ALTON PKWY, STE. 201, IRVINE, CA 92606-5024
(949) 387-3888
(949) 387-3907
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G59317
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G9317
BLUE SHIELD ID
CA
01
—
G59317
MEDICAL LICENSE NUMBER
CA
01
—
INF1012
MONARCH HEALTHCARE ID
CA
Enumeration date
05/23/2007
Last updated
07/08/2007
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