Kenneth C K Wong, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

47824 Issued in CA

Practice address

6514 Lonetree Blvd
Rocklin, CA 95765

Phone

(916) 797-2700

Fax

(916) 797-0700

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192752000000",
    "number": "1104995307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6514 LONETREE BLVD",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95765",
            "telephone_number": "916-797-2700",
            "fax_number": "916-797-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6514 LONETREE BLVD",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95765",
            "telephone_number": "916-797-2700",
            "fax_number": "916-797-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "KENNETH",
        "middle_name": "C K",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "47824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zaira Wong Lara
• A Wong Jr.
• Aubrey Resa Wong
• Clifford Thomas Wong, D.D.S., M.S.D.
• Edwin H. Wong, M.D.
• Melissa Alexandra Wong, DDS
• Peter Ray Wong, LMFT#145324
• Serena Wong
• Holli Wood
• Jill Wood

• Oral and Maxillofacial Surgery (Dentist) in Rocklin, CA
• Providers in Rocklin, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.