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 4 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