MEDICARE: EMILY WONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY22892	CA

General Provider Information

NPI Number	:	1033604178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WONG

Provider Business Mailing Address
First Line	:	640 N BROADWAY STE 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2815
Country	:	US
Telephone Number	:	213-617-3333
Fax Number	:	213-617-3318

Provider Business Practice Location Address
First Line	:	640 N BROADWAY STE 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2815
Country	:	US
Telephone Number	:	213-617-3333
Fax Number	:	213-617-3318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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Directions to “ EMILY WONG ” Practice Location

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