Healthcare Provider Details

I. General information

NPI: 1528453164
Provider Name (Legal Business Name): JULIE THENG WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE THENG KHOU

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13177 RAMONA BLVD
IRWINDALE CA
91706-3855
US

IV. Provider business mailing address

13177 RAMONA BLVD
IRWINDALE CA
91706-3855
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW102637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: