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General NPI Number Information
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NPI Number | 1326433939
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Entity Type | Organization
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Legal Business Name | REGINA S. WONG, DDS, INC.
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 677 S 2ND AVE
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City | COVINA
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State | CA
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Zip | 91723-3518
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Country | US
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Telephone | 626-858-2700
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Fax | 626-858-2754
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Provider Business Mailing Address
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Address Line | 677 S 2ND AVE
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City | COVINA
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State | CA
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Zip | 91723-3518
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Country | US
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Telephone | 626-858-2700
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Fax | 626-858-2754
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Authorized Official
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Title or Position | OWNER
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Name | DR. REGINA S. WONG
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Credential | D.D.S.
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Telephone | 626-858-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 036303
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License Number State | CA
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