MEDICARE: SIU WAN WONG, M.D.,INC

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	207R00000X	Internal Medicine Physician	A69408	CA

General Provider Information

NPI Number	:	1598025975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIU WAN WONG, M.D.,INC

Provider Business Mailing Address
First Line	:	9324 GARVEY AVE
Second Line	:	UNIT N
City	:	S EL MONTE
State	:	CA
Zip	:	91733-1088
Country	:	US
Telephone Number	:	626-575-7703
Fax Number	:

Provider Business Practice Location Address
First Line	:	9324 GARVEY AVE
Second Line	:	UNIT N
City	:	S EL MONTE
State	:	CA
Zip	:	91733-1088
Country	:	US
Telephone Number	:	626-575-7703
Fax Number	:	626-575-7712

Authorized Official
Title or Position	:	CEO
Name	:	SIU WAN WONG
Credential	:	M.D.
Telephone Number	:	626-575-7703

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	02/16/2013

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