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General NPI Number Information
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NPI Number | 1346528908
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Entity Type | Organization
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Legal Business Name | CONNIE WONG, DPM AND KI SANG YI, DPM INC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1703 TERMINO AVE SUITE 103
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City | LONG BEACH
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State | CA
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Zip | 90804-2124
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Country | US
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Telephone | 562-597-5100
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Fax | 562-597-5165
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Provider Business Mailing Address
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Address Line | 1703 TERMINO AVE SUITE 103
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City | LONG BEACH
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State | CA
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Zip | 90804-2124
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Country | US
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Telephone | 562-597-5100
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Fax | 562-597-5165
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TIV BUNLEUTH
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Credential |
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Telephone | 562-234-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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