MEDICARE: DR. SIU-FUN WONG PHARM.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
1	183500000X	Pharmacist	RPH40354	CA

General Provider Information

NPI Number	:	1255336657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIU-FUN WONG PHARM.D.

Provider Business Mailing Address
First Line	:	309 E 2ND ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-1854
Country	:	US
Telephone Number	:	909-469-5591
Fax Number	:	909-469-5539

Provider Business Practice Location Address
First Line	:	1120 N CORRIDA PL
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-1220
Country	:	US
Telephone Number	:	714-771-1819
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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