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General NPI Number Information
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NPI Number | 1588927552
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Entity Type | Individual
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Provider Name | TIN WONG DO
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Gender | Male
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Dates
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Enumeration Date | 06/24/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 711 W COLLEGE ST
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City | LOS ANGELES
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State | CA
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Zip | 90012-1163
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Country | US
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Telephone | 213-625-3182
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W COLLEGE ST STE 208
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City | LOS ANGELES
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State | CA
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Zip | 90012-1093
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Country | US
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Telephone | 213-625-3182
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Fax | 213-625-1883
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT014708
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | P13-00487
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 20A13729
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License Number State | CA
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