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NPI Code Detail

MEDICARE: MONICA WONG RDH

MEDICARE: MONICA WONG RDH
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
1124Q00000XDental Hygienist25959CA

General Provider Information

NPI Number : 1326391954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA WONG RDH
Provider Business Mailing Address
First Line : 641 LINCOLN AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-1408
Country : US
Telephone Number : 760-791-0967
Fax Number :
Provider Business Practice Location Address
First Line : 12121 WILSHIRE BLVD STE 1111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-1188
Country : US
Telephone Number : 310-820-9933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2012
Last Update Date : 10/19/2012

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