MEDICARE: DR. KAREN YOUNG WONG O.D.

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	152W00000X	Optometrist	OPT 13352	CA

General Provider Information

NPI Number	:	1801087036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN YOUNG WONG O.D.

Provider Business Mailing Address
First Line	:	23769 SUNSET CROSSING RD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1351
Country	:	US
Telephone Number	:	909-895-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 NOGALES ST STE 109
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-1309
Country	:	US
Telephone Number	:	626-965-8698
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	11/20/2008

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