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General NPI Number Information
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NPI Number | 1881672806
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Entity Type | Organization
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Legal Business Name | MICHAEL J. WONG, M.D. MEDICAL CORP.
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 201 S ALVARADO ST STE. 618
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-483-7766
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Fax | 213-483-0735
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Provider Business Mailing Address
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Address Line | 201 S ALVARADO ST STE. 618
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City | LOS ANGELES
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State | CA
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Zip | 90057-2320
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Country | US
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Telephone | 213-483-7766
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Fax | 213-483-0735
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JAMES WONG
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Credential | M.D.
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Telephone | 213-483-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G10110
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License Number State | CA
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