Kelly Kristin Wong, MD, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A82648 Issued in CA

Legal business name

KELLY KRISTIN WONG, MD, INC

Practice address

4950 Barranca Pkwy Ste 201
Irvine, CA 92604-4687

Phone

(949) 559-4480

Fax

(949) 262-7072

NPI assigned

Nov 4, 2006

Organization subpart

No

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

Authorized official

Name

Kelly Kristin Wong, M.D.

Title

M.D.

Phone

(949) 559-4480

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1162598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1114006509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 BARRANCA PKWY STE 201",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044687",
            "telephone_number": "949-559-4480",
            "fax_number": "949-262-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 BARRANCA PKWY STE 201",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926044687",
            "telephone_number": "949-559-4480",
            "fax_number": "949-262-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY KRISTIN WONG, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-04",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "KRISTIN",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "949-559-4480",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A82648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Michelle Kellen, PT, DPT, ATC
• Elizabeth Keller
• Luke Keller
• Alexis Kellogg
• Jason P Kellogg, M.D.
• Kelly Tonelli Psychologist a Professional Corporation
• Lauren Kelly
• Michael Kelly, PHARMD
• Trevor Kelly
• Kemeh Medical Corporation

• Family Medicine Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.