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General NPI Number Information
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NPI Number | 1013998616
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Entity Type | Organization
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Legal Business Name | KIN C WONG MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 435 ARDEN AVE STE 310
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City | GLENDALE
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State | CA
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Zip | 91203-1130
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Country | US
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Telephone | 818-247-6676
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Fax | 818-247-6076
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Provider Business Mailing Address
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Address Line | 435 ARDEN AVE STE 310
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City | GLENDALE
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State | CA
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Zip | 91203-4014
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Country | US
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Telephone | 818-247-6676
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Fax | 818-247-6076
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KIN C WONG
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Credential | MD
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Telephone | 818-247-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A33946
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License Number State | CA
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