Healthcare Provider Details

I. General information

NPI: 1326391954
Provider Name (Legal Business Name): MONICA WONG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD STE 1111
LOS ANGELES CA
90025-1188
US

IV. Provider business mailing address

641 LINCOLN AVE
EL CENTRO CA
92243-1408
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax:
Mailing address:
  • Phone: 760-791-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: