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General NPI Number Information
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NPI Number | 1306998927
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Entity Type | Individual
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Provider Name | KENNETH WONG PHARM D
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4950 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-5822
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Country | US
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Telephone | 323-783-8935
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Fax |
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Provider Business Mailing Address
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Address Line | 755 WINTHROP RD
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City | SAN MARINO
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State | CA
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Zip | 91108-1707
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH38753
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License Number State | CA
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