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General NPI Number Information
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NPI Number | 1578840872
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Entity Type | Individual
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Provider Name | LARRY F WONG CP
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 2669 MYRTLE AVE STE 101
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City | SIGNAL HILL
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State | CA
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Zip | 90755-2746
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Country | US
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Telephone | 562-595-6445
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Fax | 562-424-3122
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Provider Business Mailing Address
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Address Line | 2669 MYRTLE AVE STE 101
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City | SIGNAL HILL
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State | CA
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Zip | 90755-2746
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Country | US
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Telephone | 562-595-6445
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Fax | 562-424-3122
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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