Peter Wong, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103701 Issued in CA

Practice address

18519 Devonshire St
Northridge, CA 91324

Phone

(818) 831-9990

NPI assigned

Feb 15, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Charles Rodgers Professional Dental Corporation

  • General Practice Dentistry
  • Northridge, CA
  • NPI 1174618946
  NPD (past)

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572220800000",
    "number": "1154860849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18519 DEVONSHIRE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913241308",
            "telephone_number": "818-831-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18519 DEVONSHIRE ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-831-9990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "143 N Carll Ave",
            "address_purpose": "LOCATION",
            "city": "Babylon",
            "state": "NY",
            "postal_code": "11702",
            "country_code": "US",
            "telephone_number": "631-669-2330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "143 N Carll Ave",
            "address_purpose": "LOCATION",
            "city": "Babylon",
            "state": "NY",
            "postal_code": "11702",
            "country_code": "US",
            "telephone_number": "631-669-2330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "PETER",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-15",
        "last_updated": "2019-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "059863",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Wojciechowski
• George Mario Wolfus, OD
• Womens Surgicenter Inc
• Colleen Dawn Wong, LCSW
• Corrie Wong
• Lizette Wood, PTA
• Tavia Dashawn Wooley, MHRS
• Janice D Woolsey, MS CCCSP
• Shelly L Worch, RN
• Garrett Blair Work

• General Practice Dentistry in Northridge, CA
• Providers in Northridge, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; 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.