Healthcare Provider Details

I. General information

NPI: 1275243339
Provider Name (Legal Business Name): MURRAY THOMAS WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date: 07/12/2023
Reactivation Date: 08/09/2023

III. Provider practice location address

100 UCLA MEDICAL PLAZA SUITE 170
LOS ANGELES CA
90095-6902
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA185911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: