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General NPI Number Information
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NPI Number | 1326391954
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Entity Type | Individual
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Provider Name | MONICA WONG RDH
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Gender | Female
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 12121 WILSHIRE BLVD STE 1111
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City | LOS ANGELES
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State | CA
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Zip | 90025-1188
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Country | US
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Telephone | 310-820-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 641 LINCOLN AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-1408
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Country | US
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Telephone | 760-791-0967
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 25959
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License Number State | CA
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