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General NPI Number Information
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NPI Number | 1124504204
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Entity Type | Individual
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Provider Name | KRISTA WONG OD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 17430 CRENSHAW BLVD STE B
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City | TORRANCE
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State | CA
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Zip | 90504-3455
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Country | US
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Telephone | 310-532-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 17430 CRENSHAW BLVD STE B
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City | TORRANCE
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State | CA
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Zip | 90504-3455
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Country | US
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Telephone | 310-532-8900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33958
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License Number State | CA
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