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NPI Code Detail

MEDICARE: DR. PAOLA WONG O.D.

MEDICARE:  DR. PAOLA  WONG  O.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
1152W00000XOptometristOPT 13248CA

General Provider Information

NPI Number : 1245438985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAOLA WONG O.D.
Provider Business Mailing Address
First Line : 1617 S VEGA ST
Second Line :
City : ALHAMBRA
State : CA
Zip : 91801-5632
Country : US
Telephone Number : 714-292-6109
Fax Number :
Provider Business Practice Location Address
First Line : 6765 LANKERSHIM BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91606-1614
Country : US
Telephone Number : 818-982-0076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2007
Last Update Date : 01/03/2022

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Directions to “ DR. PAOLA WONG O.D.” Practice Location

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