MEDICARE: DR. DEWEY T 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	1835P1200X	Pharmacotherapy Pharmacist	RPH 30700	CA
2	1835P1300X	Psychiatric Pharmacist	RPH 30700	CA

General Provider Information

NPI Number	:	1558358044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEWEY T WONG PHARM.D.

Provider Business Mailing Address
First Line	:	19038 BRASILIA DR
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1520
Country	:	US
Telephone Number	:	818-368-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	13652 CANTARA ST
Second Line	:	KAISER PERMANENTE
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5423
Country	:	US
Telephone Number	:	818-375-2683
Fax Number	:

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	09/11/2025

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