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General NPI Number Information
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NPI Number | 1790385227
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Entity Type | Organization
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Legal Business Name | JOHNSON ANN WONG DENTAL CORPORATION
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 6512 N FIGUEROA ST STE 3
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City | LOS ANGELES
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State | CA
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Zip | 90042-2155
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Country | US
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Telephone | 323-521-9833
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Fax |
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Provider Business Mailing Address
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Address Line | 223 N ELECTRIC AVE
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City | ALHAMBRA
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State | CA
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Zip | 91801-1929
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Country | US
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Telephone | 626-679-0103
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIN CHO WONG
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Credential | DDS
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Telephone | 626-679-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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