Provider Demographics
NPI:1437315967
Name:WONG, DONOVAN (MD)
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 TABLE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3578
Mailing Address - Country:US
Mailing Address - Phone:530-538-7705
Mailing Address - Fax:530-538-7852
Practice Address - Street 1:82 TABLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3578
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:530-538-7852
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP91382084P0800X
CAA1037662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry