Healthcare Provider Details

I. General information

NPI: 1477871838
Provider Name (Legal Business Name): CHUNG YING WONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S VERMONT AVE
LOS ANGELES CA
90006-4525
US

IV. Provider business mailing address

1815 S VERMONT AVE
LOS ANGELES CA
90006-4525
US

V. Phone/Fax

Practice location:
  • Phone: 323-735-0774
  • Fax: 323-735-1803
Mailing address:
  • Phone: 323-735-0774
  • Fax: 323-735-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 35074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: