Healthcare Provider Details

I. General information

NPI: 1023769270
Provider Name (Legal Business Name): CHI CHIU JAMES WONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE STE 404
WESTMINSTER CA
92683-2939
US

IV. Provider business mailing address

13950 MILTON AVE STE 404
WESTMINSTER CA
92683-2939
US

V. Phone/Fax

Practice location:
  • Phone: 650-250-1868
  • Fax:
Mailing address:
  • Phone: 650-250-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: