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General NPI Number Information
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NPI Number | 1508109182
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Entity Type | Individual
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Provider Name | JOHN W.C. WONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 1613 CHELSEA RD # 803
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City | SAN MARINO
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State | CA
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Zip | 91108-2419
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Country | US
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Telephone | 626-795-8082
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Fax | 626-795-8087
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Provider Business Mailing Address
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Address Line | 1613 CHELSEA RD # 803
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City | SAN MARINO
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State | CA
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Zip | 91108-2419
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Country | US
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Telephone | 626-795-8082
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Fax | 626-795-8087
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | CFE27640
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License Number State | CA
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