Active NPI
Jonathan James Wong, DDS
- Pediatric Dentistry
- Rancho Mission Viejo, CA
National Provider Identifier
1275277485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 110073
- Practice address
- 30492 Gateway PL Ste 220
Rancho Mission Viejo, CA 92694-1899 - Phone
- (949) 767-3925
- NPI assigned
- Apr 24, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 110073 | CA | Primary |
Addresses
Primary practice location
30492 Gateway PL Ste 220
Rancho Mission Viejo, CA 92694-1899
Mailing address
760 Washington Blvd Apt 103
Marina del Rey, CA 90292-6679
Phone (760) 809-2862
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 |
|---|---|---|---|
| 110073 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1275277485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 WASHINGTON BLVD APT 103",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902926679",
"telephone_number": "760-809-2862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30492 GATEWAY PL STE 220",
"city": "RANCHO MISSION VIEJO",
"state": "CA",
"postal_code": "926941899",
"telephone_number": "949-767-3925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JONATHAN",
"middle_name": "JAMES",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-24",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "110073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.