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General NPI Number Information
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NPI Number | 1427154715
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Entity Type | Individual
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Provider Name | KENNETH WONG PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11201 BENTON ST. (119)
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City | LOMA LINDA
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State | CA
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Zip | 92357
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3263
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Provider Business Mailing Address
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Address Line | 466 SONORA CIRCLE
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-798-0300
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 48265
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License Number State | CA
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