Healthcare Provider Details

I. General information

NPI: 1164044376
Provider Name (Legal Business Name): MEGAN DONGSUN WON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

13044 PACIFIC PROMENADE APT 207
PLAYA VISTA CA
90094-4005
US

V. Phone/Fax

Practice location:
  • Phone: 562-556-3352
  • Fax:
Mailing address:
  • Phone: 562-556-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: