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General NPI Number Information
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NPI Number | 1356893309
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Entity Type | Organization
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Legal Business Name | JESSICA J WONG, MD, INC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 1808 VERDUGO BLVD SUITE 418
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City | GLENDALE
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State | CA
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Zip | 91208-1477
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Country | US
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Telephone | 818-928-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 VERDUGO BLVD SUITE 418
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City | GLENDALE
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State | CA
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Zip | 91208-1477
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Country | US
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Telephone | 818-928-1045
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER/PRESIDENT
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Name | DR. JESSICA J WONG
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Credential | MD
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Telephone | 818-928-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A120973
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License Number State | CA
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