MEDICARE: LOUIS & MARY JO 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	332B00000X	Durable Medical Equipment & Medical Supplies	02889620001	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	PHY30761	CA
4	3336C0003X	Community/Retail Pharmacy

Other Identifiers

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

General Provider Information

NPI Number	:	1174689715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUIS & MARY JO WONG

Provider Business Mailing Address
First Line	:	2200 W 3RD ST STE 390
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-483-5910
Fax Number	:	213-483-5913

Provider Business Practice Location Address
First Line	:	2200 W 3RD ST STE 390
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-483-5910
Fax Number	:	213-483-5913

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. LOUIS TAI WAI WONG
Credential	:	PHARM D
Telephone Number	:	213-483-5910

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	01/29/2021

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Directions to “LOUIS & MARY JO WONG ” Practice Location

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