Healthcare Provider Details

I. General information

NPI: 1073725768
Provider Name (Legal Business Name): HANSON P WONG M D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 ARTESIA BLVD SUITE 201
BELLFLOWER CA
90706-6768
US

IV. Provider business mailing address

10230 ARTESIA BLVD SUITE 201
BELLFLOWER CA
90706-6768
US

V. Phone/Fax

Practice location:
  • Phone: 562-804-7223
  • Fax: 562-804-0165
Mailing address:
  • Phone: 562-804-7223
  • Fax: 562-804-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG63718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG63718
License Number StateCA

VIII. Authorized Official

Name: HANSON PAO-SANG WONG
Title or Position: OWNER
Credential: M.D.
Phone: 562-804-7223