NPIMap

Individual provider Active NPI

Clyde Yuen Wong, MD

  • Family Medicine Physician
  • Stockton, CA
National Provider Identifier
1487686473
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G53166 Issued in CA
Practice address
77 W March LN Ste a
Stockton, CA 95207-5724
Phone
(209) 477-5552
Fax
(209) 477-5553
NPI assigned
Jul 7, 2006
Last updated
Mar 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G53166 CA Primary

Addresses

Primary practice location

77 W March LN Ste a
Stockton, CA 95207-5724

Mailing address

77 W March LN Ste a
Stockton, CA 95207-5724
Phone (209) 477-5552

Other identifiers 2

IdentifierTypeStateIssuer
00G531660MedicaidCA
P00379497OtherMEDICARE RR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040325000536 CA Practitioner - Family Practice 1951292465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Stanford University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HT Family Physicians IncGroup PAC ID 1254494479, 4 clinicians

Practice addresses (Care Compare)

999 S Fairmont Ave
Suite 215
Lodi, CA 95240-5142
Phone (209) 477-5552

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emanuel Medical Center, Inc. Past Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
HT Family Physicians Family Medicine Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Hanford Regional Physicians Group, Inc Family Medicine PastSince Dec 1, 2003 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: cwong24816@hpmg.direct-ci.net

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1487686473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W MARCH LN STE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075724",
            "telephone_number": "209-477-5552",
            "fax_number": "209-477-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W MARCH LN STE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075724",
            "telephone_number": "209-477-5552",
            "fax_number": "209-477-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "CLYDE",
        "middle_name": "YUEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G53166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G531660",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00379497",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.