Grace Wong MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A96700 Issued in CA

Legal business name

GRACE WONG MD INC

Practice address

3808 W Riverside Dr Ste 201
Burbank, CA 91505-4339

Phone

(818) 563-1449

NPI assigned

Nov 23, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Grace Wong, M.D.NPI 1053504902

Title

President

Phone

(626) 347-9074

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

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

• Grace I Wong, M.D.

  • Internal Medicine Physician
  • Burbank, CA
  • NPI 1053504902
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1659648384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 W RIVERSIDE DR STE 201",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054339",
            "telephone_number": "626-347-9074",
            "fax_number": "818-509-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 W RIVERSIDE DR STE 201",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054339",
            "telephone_number": "818-563-1449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3808 W Riverside Dr",
            "address_2": "Suite 406",
            "address_purpose": "LOCATION",
            "city": "Burbank",
            "state": "CA",
            "postal_code": "915054325",
            "country_code": "US",
            "telephone_number": "626-347-9074",
            "fax_number": "818-509-5939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACE WONG MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-23",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-347-9074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A96700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1053504902",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynette Goto-Tamusaits, CMT
• Joshua Gottlieb, D.O.
• Richard A Gottlieb, RN
• Jessalynn Goulette
• Gourgen Almasi DDS a Proffessional Corporation
• Cocise Antranette Grace, LPCC
• Danielle Macqueen Graham, M.D.
• Erin Graham, PH.D.
• Mylissa Graham
• Sharon Scarlet Gramajo-Reyes

• Internal Medicine Physician in Burbank, CA
• Providers in Burbank, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.