Healthcare Provider Details

I. General information

NPI: 1942463534
Provider Name (Legal Business Name): WAYLEY DRAGON LOUIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 100
HARBOR CITY CA
90710-2084
US

IV. Provider business mailing address

2550 W MAIN ST STE 301
ALHAMBRA CA
91801-7003
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-5800
  • Fax:
Mailing address:
  • Phone: 626-457-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: