MEDICARE: WONGEAL LLC

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	342000000X	Transportation Network Company
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1073213468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONGEAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 473722
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80047-3722
Country	:	US
Telephone Number	:	720-936-1816
Fax Number	:

Provider Business Practice Location Address
First Line	:	17946 E 95TH AVE
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9652
Country	:	US
Telephone Number	:	720-936-1816
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	ZELALEM YIGZAW AYELE
Credential	:
Telephone Number	:	720-936-1816

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	04/01/2024

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Directions to “WONGEAL LLC ” Practice Location

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