Provider Demographics
NPI:1174625008
Name:WONG, CAROLINE (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
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:PO BOX 11959
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-3959
Mailing Address - Country:US
Mailing Address - Phone:661-869-2600
Mailing Address - Fax:661-869-2003
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:SUITE A100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-869-2600
Practice Address - Fax:661-869-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75701207RN0300X
CAG757011208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G757010Medicaid
CA00G757011Medicaid
P00379026OtherMEDICARE RAILROAD
CA00G757011Medicaid
CA00G757011Medicare PIN