MEDICARE: JANET WONG AND JENNIFER WONG DENTAL CORPORATION

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	122300000X	Dentist	52131	CA
2	122300000X	Dentist	49025	CA

General Provider Information

NPI Number	:	1679742365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANET WONG AND JENNIFER WONG DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	11262 WASHINGTON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4616
Country	:	US
Telephone Number	:	310-390-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11262 WASHINGTON BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4616
Country	:	US
Telephone Number	:	310-390-6500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANET ELIZABETH WONG
Credential	:	D.D.S.
Telephone Number	:	310-390-6500

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	06/17/2008

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