Organization Active NPI

Frank Fook Y. Wong, MD, Inc.

  • Specialist
  • San Jose, CA
National Provider Identifier
1053500595
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G66621 Issued in CA
Legal business name
FRANK FOOK Y. WONG, MD, INC.
Practice address
175 N Jackson Ave
# 104
San Jose, CA 95116-1909
Phone
(408) 258-6566
Fax
(408) 258-6660
NPI assigned
Oct 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Frank Fook Y. Wong, M.D.
Title
President of Inc.
Phone
(408) 258-6566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X G66621 CA Primary

Addresses

Primary practice location

175 N Jackson Ave
# 104
San Jose, CA 95116-1909

Mailing address

175 N Jackson Ave
# 104
San Jose, CA 95116-1909
Phone (408) 258-6566

Other identifiers 2

IdentifierTypeStateIssuer
G66621OtherCACALIFORNIA M.D. LICENCE #
ZZZ26797ZOtherCAMEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050315000391 CA Part B Supplier - Clinic/Group Practice 8022063841 Receives reassigned benefits from 1 practitioner
Practice locations: San Jose, CA

National Provider Directory

National Provider Directory

Locations

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1053500595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 N JACKSON AVE",
            "address_2": "# 104",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161909",
            "telephone_number": "408-258-6566",
            "fax_number": "408-258-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N JACKSON AVE",
            "address_2": "# 104",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161909",
            "telephone_number": "408-258-6566",
            "fax_number": "408-258-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRANK FOOK Y. WONG, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "FOOK     Y.",
        "authorized_official_title_or_position": "PRESIDENT OF INC.",
        "authorized_official_telephone_number": "408-258-6566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G66621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA M.D. LICENCE #",
            "identifier": "G66621",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ26797Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.