MEDICARE: DR. CAROLYN WONG DPM

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	213E00000X	Podiatrist	EL1632	CA

General Provider Information

NPI Number	:	1629265095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN WONG DPM

Provider Business Mailing Address
First Line	:	PO BOX629
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-0629
Country	:	US
Telephone Number	:	323-264-6157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 E 1ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-2326
Country	:	US
Telephone Number	:	323-264-6157
Fax Number	:

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	01/07/2009

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Directions to “ DR. CAROLYN WONG DPM” Practice Location

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