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NPI Code Detail

MEDICARE: SIMON WONG

MEDICARE:   SIMON  WONG
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
1183500000XPharmacist66641CA

General Provider Information

NPI Number : 1649541269
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON WONG
Provider Business Mailing Address
First Line : 7299 LAGUNA BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5059
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7299 LAGUNA BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5059
Country : US
Telephone Number : 916-691-4412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2012
Last Update Date : 01/13/2012

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Directions to “ SIMON WONG ” Practice Location

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