MEDICARE: BUU KIM WONG D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E2351	CA

General Provider Information

NPI Number	:	1306980107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUU KIM WONG D.P.M.

Provider Business Mailing Address
First Line	:	500 E CARSON ST
Second Line	:	STE 112
City	:	CARSON
State	:	CA
Zip	:	90745-2713
Country	:	US
Telephone Number	:	310-518-3972
Fax Number	:	310-518-3998

Provider Business Practice Location Address
First Line	:	500 E CARSON ST
Second Line	:	STE 112
City	:	CARSON
State	:	CA
Zip	:	90745-2713
Country	:	US
Telephone Number	:	310-518-3972
Fax Number	:	310-518-3998

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/23/2008

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Directions to “ BUU KIM WONG D.P.M.” Practice Location

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