Healthcare Provider Details

I. General information

NPI: 1437736550
Provider Name (Legal Business Name): JESSICA WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 402
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

12462 PUTNAM ST STE 402
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2788
  • Fax:
Mailing address:
  • Phone: 562-967-2788
  • Fax: 562-789-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA207526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: