MEDICARE: ADULT & CHILD ALLERGY-ASTHMA CLINIC 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	207K00000X	Allergy & Immunology Physician	G51644	CA

General Provider Information

NPI Number	:	1801909668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & CHILD ALLERGY-ASTHMA CLINIC INC

Provider Business Mailing Address
First Line	:	1850 S AZUSA AVE STE 206
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6853
Country	:	US
Telephone Number	:	626-810-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 S AZUSA AVE STE 206
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6853
Country	:	US
Telephone Number	:	626-810-5450
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. STEPHEN CURTIS WONG
Credential	:	M.D.
Telephone Number	:	626-284-3400

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/01/2014

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