Healthcare Provider Details

I. General information

NPI: 1780703983
Provider Name (Legal Business Name): YEP H. WONG, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVE # 334
INGLEWOOD CA
90301-4502
US

IV. Provider business mailing address

323 N PRAIRIE AVE # 334
INGLEWOOD CA
90301-4502
US

V. Phone/Fax

Practice location:
  • Phone: 310-680-9300
  • Fax: 310-672-1347
Mailing address:
  • Phone: 310-680-9300
  • Fax: 310-672-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA14748
License Number StateCA

VIII. Authorized Official

Name: YEP H WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-680-9300