Kelly Wong, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA62248 Issued in CA

Practice address

24431 Calle de la Louisa Ste 200
Laguna Hills, CA 92653-7641

Phone

(949) 266-0216

NPI assigned

Jan 31, 2023

Sex

Female

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thomas J Asciuto MD Corporation

  • Pulmonary Disease Physician
  • Fountain Valley, CA
  • NPI 1659630622
  Medicare reassignment
• Katherine Bao-Shian Lee, M.D., a Professional Corporation

  • Dermatology Physician
  • Laguna Hills, CA
  • NPI 1881012656
  NPD (past)

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1134825284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20687 AMAR RD STE 2-818",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917895044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24431 CALLE DE LA LOUISA STE 200",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926537641",
            "telephone_number": "949-266-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "KELLY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA62248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorming Wong, M.D.
• Edward K Wong Jr., MD
• James G. Wong, M.D.
• Jason T Wong, M.D.
• Julie Wong, O.D.
• Mabel Wong
• Matthew Wong
• Michael Alan Wong, MD
• Lisa Woo, B.S.
• Erin Woodhouse, COTA

• Physician Assistant in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.