Active NPI
John W Wong
- Dentist
- San Jose, CA
National Provider Identifier
1114201555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28111
- Practice address
- 3151 S White Rd
Suite 201
San Jose, CA 95148-4045 - Phone
- (408) 945-9911
- NPI assigned
- Oct 4, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 28111 | CA | Primary |
Addresses
Primary practice location
3151 S White Rd
Suite 201
San Jose, CA 95148-4045
Mailing address
3151 S White Rd
Suite 201
San Jose, CA 95148-4045
Phone (408) 945-9911
Other names 1
- Dr. John W Wong
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28111 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1114201555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3151 S WHITE RD",
"address_2": "SUITE 201",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951484045",
"telephone_number": "408-945-9911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3151 S WHITE RD",
"address_2": "SUITE 201",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951484045",
"telephone_number": "408-945-9911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JOHN",
"middle_name": "W",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-04",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "28111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOHN",
"last_name": "WONG",
"middle_name": "W",
"prefix": "DR.",
"credential": "DMD",
"code": "2",
"type": "Professional Name"
}
]
}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 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.