Healthcare Provider Details

I. General information

NPI: 1073901369
Provider Name (Legal Business Name): CHRISTOPHER DAVID WONG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD
PASADENA CA
91105-2544
US

IV. Provider business mailing address

1301 VIOLETA DR
ALHAMBRA CA
91801-5338
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-8536
  • Fax:
Mailing address:
  • Phone: 626-570-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: