Individual provider Active NPI

Johnson Kar Tsun Wong, M.D.

  • Internal Medicine Physician
  • Sonora, CA
National Provider Identifier
1184875759
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G79608 Issued in CA
Practice address
14568A Mono Way
Sonora, CA 95370-8858
Phone
(209) 768-1217
Fax
(209) 533-2061
NPI assigned
Sep 23, 2005
Reactivated
Oct 1, 2008
Last updated
Oct 1, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G79608 CA Primary

Addresses

Primary practice location

14568A Mono Way
Sonora, CA 95370-8858

Mailing address

14568A Mono Way
Sonora, CA 95370-8858
Phone (209) 768-1217

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)
Enrolled
Credentials
Doctor of Medicine

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1184875759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14568A MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953708858",
            "telephone_number": "209-768-1217",
            "fax_number": "209-533-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14568A MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953708858",
            "telephone_number": "209-768-1217",
            "fax_number": "209-533-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "replacement_npi": "1184875759",
        "last_name": "WONG",
        "first_name": "JOHNSON",
        "middle_name": "KAR TSUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2008-10-01",
        "deactivation_date": "2008-08-21",
        "reactivation_date": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G79608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.