Individual
DR. RANDOLPH WY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 TROUSDALE DR, 5TH FLOOR, BURLINGAME, CA 94010-4506
(650) 652-8787
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(650) 652-8787
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G76113
CA
246ZS0410X
Surgical Technologist
G76113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G76113
LICENSE
CA
05
—
YYY34803Y
—
CA
Enumeration date
02/12/2007
Last updated
06/19/2020
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