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General NPI Number Information
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NPI Number | 1811870512
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Entity Type | Individual
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Provider Name | JENNIFER TOMIKO WONG PTA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 18785 BROOKHURST ST STE 104
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7300
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Country | US
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Telephone | 657-301-4967
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Fax |
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Provider Business Mailing Address
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Address Line | 18402 LAURELBROOK CIR
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City | CERRITOS
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State | CA
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Zip | 90703-6353
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Country | US
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Telephone | 562-455-7050
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 54254
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License Number State | CA
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