Healthcare Provider Details

I. General information

NPI: 1134298185
Provider Name (Legal Business Name): KUAN POK WONG M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 ARTESIA BLVD #102
BELLFLOWER CA
90706-6763
US

IV. Provider business mailing address

10230 ARTESIA BLVD #102
BELLFLOWER CA
90706-6763
US

V. Phone/Fax

Practice location:
  • Phone: 562-866-1764
  • Fax: 562-867-7123
Mailing address:
  • Phone: 562-866-1764
  • Fax: 562-867-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA26255
License Number StateCA

VIII. Authorized Official

Name: DR. KUAN POK WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-866-1764