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General NPI Number Information
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NPI Number | 1871678557
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Entity Type | Organization
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Legal Business Name | KING YUE WONG OD INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1431 SEVENTH STREET SUITE #201
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City | SANTA MONICA
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State | CA
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Zip | 90401-2638
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Country | US
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Telephone | 310-450-9998
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Fax | 310-450-8580
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Provider Business Mailing Address
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Address Line | 316 SOUTH KENTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90049-4022
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Country | US
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Telephone | 310-471-9618
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Fax | 310-450-8580
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Authorized Official
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Title or Position | DIRECTOR OWNER
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Name | DR. KING YUE WONG
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Credential | OD
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Telephone | 310-471-9618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT12461TPA
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | OPT12461TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OPT12461TPA
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License Number State | CA
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