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NPI Code Detail

MEDICARE: DR. SUSIE YIN-PENG WONG M.D.

MEDICARE: DR. SUSIE YIN-PENG WONG M.D.
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
1207W00000XOphthalmology PhysicianC042888CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144250994
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSIE YIN-PENG WONG M.D.
Provider Business Mailing Address
First Line : 18617 GALE AVE
Second Line :
City : CITY OF INDUSTRY
State : CA
Zip : 91748-1342
Country : US
Telephone Number : 626-912-1871
Fax Number : 626-912-6766
Provider Business Practice Location Address
First Line : 18617 GALE AVE
Second Line :
City : CITY OF INDUSTRY
State : CA
Zip : 91748-1342
Country : US
Telephone Number : 626-912-1871
Fax Number : 626-912-6766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 04/18/2012

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