MEDICARE: MISS JENJIRA 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	225700000X	Massage Therapist	79537	CA

General Provider Information

NPI Number	:	1063375772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENJIRA WONG

Provider Business Mailing Address
First Line	:	133 N SERRANO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 N SERRANO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4205
Country	:	US
Telephone Number	:	347-822-6360
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ MISS JENJIRA WONG ” Practice Location

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