MEDICARE: KING YUE WONG OD INC

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	OPT12461TPA	CA
2	152WL0500X	Low Vision Rehabilitation Optometrist	OPT12461TPA	CA
3	152WP0200X	Pediatric Optometrist	OPT12461TPA	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SD0124611	OTHER	CA	MEDI CAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871678557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING YUE WONG OD INC

Provider Business Mailing Address
First Line	:	316 SOUTH KENTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4022
Country	:	US
Telephone Number	:	310-471-9618
Fax Number	:	310-450-8580

Provider Business Practice Location Address
First Line	:	1431 SEVENTH STREET
Second Line	:	SUITE #201
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2638
Country	:	US
Telephone Number	:	310-450-9998
Fax Number	:	310-450-8580

Authorized Official
Title or Position	:	DIRECTOR OWNER
Name	:	DR. KING YUE WONG
Credential	:	OD
Telephone Number	:	310-471-9618

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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Directions to “KING YUE WONG OD INC ” Practice Location

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