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General NPI Number Information
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NPI Number | 1801909668
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Entity Type | Organization
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Legal Business Name | ADULT & CHILD ALLERGY-ASTHMA CLINIC INC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 1850 S AZUSA AVE STE 206
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6853
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Country | US
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Telephone | 626-810-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 S AZUSA AVE STE 206
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6853
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Country | US
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Telephone | 626-810-5450
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. STEPHEN CURTIS WONG
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Credential | M.D.
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Telephone | 626-284-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G51644
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License Number State | CA
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