Healthcare Provider Details

I. General information

NPI: 1942378039
Provider Name (Legal Business Name): LAI JING WONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 SUNSET BOULEVARD INPATIENT PHARMACY GROUND FLOOR
LOS ANGELES CA
90027-5969
US

IV. Provider business mailing address

4867 SUNSET BOULEVARD
LOS ANGELES CA
90027-5969
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-8308
  • Fax: 323-783-4920
Mailing address:
  • Phone: 323-783-9700
  • Fax: 323-783-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH31422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06960
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: