Healthcare Provider Details

I. General information

NPI: 1699609826
Provider Name (Legal Business Name): ALETHEA WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S COAST DR STE 225
COSTA MESA CA
92626-7757
US

IV. Provider business mailing address

13800 BIOLA AVE U1167B BIOLA CAMPUS STORE
LA MIRADA CA
90639
US

V. Phone/Fax

Practice location:
  • Phone: 949-743-1457
  • Fax:
Mailing address:
  • Phone: 628-252-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: