=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619861366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHING CHING WONG RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 S 2ND AVE
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-214-1480
-----------------------------------------------------
Fax | 626-214-1476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 N PALOMARES ST APT B117
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-4762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-316-3626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86292955
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------