MEDICARE: EMILY CHU 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY22892	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002913	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700813060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY CHU WONG

Provider Business Mailing Address
First Line	:	640 N BROADWAY
Second Line	:	STE 3
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2815
Country	:	US
Telephone Number	:	213-617-3333
Fax Number	:	213-617-3318

Provider Business Practice Location Address
First Line	:	640 N BROADWAY
Second Line	:	STE 3
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2815
Country	:	US
Telephone Number	:	213-617-3333
Fax Number	:	213-617-3318

Authorized Official
Title or Position	:	RPH
Name	:	EMILY WONG
Credential	:	RPH
Telephone Number	:	213-617-3333

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	03/28/2017

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