Granger B Wong M D Inc

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

A54333 Issued in CA

Legal business name

GRANGER B WONG M D INC

Practice address

576 N Sunrise Ave
Suite 120
Roseville, CA 95661-2841

Phone

(916) 791-7088

Fax

(916) 791-7088

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Granger Wong, MDNPI 1225013790

Title

President

Phone

(916) 791-7088

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, HI2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Granger Bradford Wong, MD,DMD,FACS

  • Plastic Surgery Physician
  • Sacramento, CA
  • NPI 1225013790

  HI

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1609922962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 N SUNRISE AVE",
            "address_2": "SUITE 120",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612841",
            "telephone_number": "916-791-7088",
            "fax_number": "916-791-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 N SUNRISE AVE",
            "address_2": "SUITE 120",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612841",
            "telephone_number": "916-791-7088",
            "fax_number": "916-791-7088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER B WONG M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "GRANGER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-791-7088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A54333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda A Grady
• Angelica Maria Manzo Graham, MS
• Billy D Graham, P.A.-C.
• Lindsay Graham, BS SLPA
• Kevin Gramyk, MD
• Danielle N Granieri, D.O.
• Jocelyn Marlen Granillo Gallegos
• Granite Bay Surgery Center, LLC
• Granite Pointe Eye Care, Inc., an Optometric Corporation
• Granite Pointe Eye Care, Inc., an Optometric Corporation

• Plastic Surgery Physician in Roseville, CA
• Providers in Roseville, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.