Provider Demographics
NPI:1578543963
Name:WONG, ANDREW KI (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KI
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3443 VILLA LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-253-8280
Mailing Address - Fax:707-253-7023
Practice Address - Street 1:3443 VILLA LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-253-8280
Practice Address - Fax:707-253-7023
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64276207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642760Medicaid
E83071Medicare UPIN
CA00G642760Medicaid