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General NPI Number Information
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NPI Number | 1205457157
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Entity Type | Individual
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Provider Name | VIVIAN WING-WAN WONG
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Gender | Female
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 704-964-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 25654 HURON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-3703
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Country | US
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Telephone | 704-964-5729
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 81333
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License Number State | CA
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