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General NPI Number Information
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NPI Number | 1396917936
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Entity Type | Individual
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Provider Name | PAULINE PHAM WONG DDS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 3811 BEDFORD CANYON RD STE 105
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City | CORONA
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State | CA
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Zip | 92883-0789
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Country | US
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Telephone | 951-270-0211
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Fax | 951-270-0702
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Provider Business Mailing Address
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Address Line | PO BOX 27250
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City | ANAHEIM
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State | CA
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Zip | 92809-0297
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Country | US
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Telephone | 951-270-0211
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Fax | 951-270-0702
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 53643
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License Number State | CA
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