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General NPI Number Information
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NPI Number | 1750412714
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Entity Type | Organization
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Legal Business Name | ALLEN KING WONG, DDS, INC.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 320 W BADILLO ST STE 201
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City | COVINA
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State | CA
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Zip | 91723-1833
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Country | US
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Telephone | 626-966-3131
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Fax | 626-966-7603
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Provider Business Mailing Address
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Address Line | 320 W BADILLO ST STE 201
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City | COVINA
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State | CA
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Zip | 91723-1833
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Country | US
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Telephone | 626-966-3131
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Fax | 626-966-7603
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. MARK WONG
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Credential | M.S., D.D.S.
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Telephone | 626-966-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 42021
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 14905
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License Number State | CA
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