Active NPI
Raymond S Wong, MEDICAL DOCTOR
- Diagnostic Radiology Physician
- Pasadena, CA
National Provider Identifier
1952391799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- G13482
- Practice address
- 100 W California Blvd
Pasadena, CA 91105-3010 - Phone
- (626) 397-5139
- Fax
- (626) 397-3409
- NPI assigned
- Oct 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | G13482 | CA | |
| Nuclear Radiology Physician | 2085N0904X | G13482 | CA | |
| Diagnostic Radiology Physician | 2085R0202X | G13482 | CA | Primary |
| Vascular & Interventional Radiology Physician | 2085R0204X | G13482 | CA | |
| Diagnostic Ultrasound Physician | 2085U0001X | G13482 | CA |
Addresses
Primary practice location
100 W California Blvd
Pasadena, CA 91105-3010
Mailing address
223 N 1St Ave
Suite 201
Arcadia, CA 91006-7089
Phone (626) 821-1411
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G134820 | Medicaid | CA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G13482 | CA | MD | Diagnostic Ultrasound Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1952391799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 N 1ST AVE",
"address_2": "SUITE 201",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910067089",
"telephone_number": "626-821-1411",
"fax_number": "626-821-0406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W CALIFORNIA BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053010",
"telephone_number": "626-397-5139",
"fax_number": "626-397-3409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "RAYMOND",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MEDICAL DOCTOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-24",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "CA",
"license": "G13482",
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "CA",
"license": "G13482",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "G13482",
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "CA",
"license": "G13482",
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "CA",
"license": "G13482",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G134820",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.