Healthcare Provider Details

I. General information

NPI: 1851465686
Provider Name (Legal Business Name): MATTHEW LOT KAI WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 CAMINO DEL SOL
TORRANCE CA
90505-5017
US

IV. Provider business mailing address

PO BOX 3003
SOUTH PASADENA CA
91031-6003
US

V. Phone/Fax

Practice location:
  • Phone: 424-400-7748
  • Fax: 424-400-7749
Mailing address:
  • Phone: 424-400-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA84553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: