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General NPI Number Information
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NPI Number | 1154509131
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Entity Type | Individual
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Provider Name | DARRELL L WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 117 E LIVE OAK AVE SUITE 101
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City | ARCADIA
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State | CA
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Zip | 91006-5269
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Country | US
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Telephone | 626-446-8492
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Fax |
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Provider Business Mailing Address
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Address Line | 763 LA PORTADA ST
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City | S PASADENA
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State | CA
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Zip | 91030-3626
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Country | US
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Telephone | 323-255-7369
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A041390
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License Number State | CA
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