Healthcare Provider Details

I. General information

NPI: 1609089671
Provider Name (Legal Business Name): ANNA MEI TING WONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 HARGRAVE DR
LOS ANGELES CA
90068-2218
US

IV. Provider business mailing address

2504 HARGRAVE DR
LOS ANGELES CA
90068-2218
US

V. Phone/Fax

Practice location:
  • Phone: 323-462-5809
  • Fax:
Mailing address:
  • Phone: 323-462-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT933A
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: