Individual
DR. WADE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9300 CAMPUS POINT DR, 7756, LA JOLLA, CA 92037
(858) 657-6650
Mailing address
9300 CAMPUS POINT DR, MAIL CODE 7756, LA JOLLA, CA 92037
(858) 657-6650
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
20A3872
CA
2085N0700X
Neuroradiology Physician
Primary
20A3872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX38720
—
CA
Enumeration date
10/19/2006
Last updated
10/09/2007
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