Individual provider Active NPI

Vanessa Lee Wong, M.D.

  • Pediatric Critical Care Medicine Physician
  • San Diego, CA
National Provider Identifier
1154680650
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
A130899 Issued in CA
Practice address
3020 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-5855
NPI assigned
May 4, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X A130899 CA
Pediatric Critical Care Medicine Physician 2080P0203X A130899 CA Primary

Addresses

Primary practice location

3020 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other practice location 1

505 S Main St
Suite 525
Orange, CA 92868-4509
Phone (714) 456-5631

Other practice location 2

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-7002

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address VWONG449556@DIRECT.MED.UTAH.EDU Direct University of Utah

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231206002855 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 7517383235 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A130899CAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Uci Dept of Pediatrics CurrentSince Oct 22, 2023 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince Oct 31, 2024 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince Oct 31, 2024 Accepting new patients
Pediatric Subspecialty Faculty, Inc. Past Accepting new patients
University of California Irvine Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Aug 18, 2024 Accepting new patients

Locations

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

505 S Main St
Ste 525
Orange, CA 92868
Phone (714) 456-5631

1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

Interoperability endpoints

  • Direct secure messaging: vwong449556@direct.med.utah.edu

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1154680650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 S Main St",
            "address_2": "Suite 525",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928684509",
            "country_code": "US",
            "telephone_number": "714-456-5631",
            "fax_number": "714-285-0389",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 The City Dr S",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683201",
            "country_code": "US",
            "telephone_number": "714-456-7002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "VANESSA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-04",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A130899",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "A130899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "VWONG449556@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.