Jack K Wong | Costa Mesa, CA • PECOS Search

Jack K Wong

Family Medicine

Allopathic & Osteopathic Physicians

3200 Bristol St Ste 600, Costa Mesa, CA 92626-1810

PECOS Enrollment

Based on the most recent information from CMS, provider Jack K Wong does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 24 days ago.

Profile Details

Provider ID
1790725539
Provider Type
Individual
Full Name
Wong, Jack K
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
6/8/2006
Last Updated
11/19/2025

Contact Information

Practice Location

3200 Bristol St Ste 600, Costa Mesa, CA 92626-1810

Unlisted Fax

Mailing Location

3200 Bristol St Ste 600, Costa Mesa, CA 92626-1810

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License C50860 California