Healthcare Provider Details

I. General information

NPI: 1427173301
Provider Name (Legal Business Name): CINDY LING WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD CHILDREN'S HOSPITAL LOS ANGELES, MAILSTOP #94
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD CHILDREN'S HOSPITAL LOS ANGELES, MAILSTOP #94
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6177
  • Fax: 323-361-8106
Mailing address:
  • Phone: 323-361-6177
  • Fax: 323-361-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number230697
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: