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General NPI Number Information
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NPI Number | 1386264406
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Entity Type | Individual
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Provider Name | GREGORY JAMISON WONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2020
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-825-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A183176
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | A183176
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A183176
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A183176
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A183176
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License Number State | CA
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