Healthcare Provider Details

I. General information

NPI: 1609385426
Provider Name (Legal Business Name): MEI-LING C WONG PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4280 VIA ARBOLADA UNIT 111
LOS ANGELES CA
90042-5077
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2109
  • Fax:
Mailing address:
  • Phone: 415-517-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number23846
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number23846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: