MEDICARE: MELISSA WONG DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40873	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1689563637	OTHER		NPPES

General Provider Information

NPI Number	:	1225452030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WONG DPT

Provider Business Mailing Address
First Line	:	1503 LAKE SHORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 LAKE SHORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2531
Country	:	US
Telephone Number	:	415-819-7866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	07/15/2025

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