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NPI Code Detail

MEDICARE: DR. TIN S WONG DO MEDICAL CORPORATION

MEDICARE: DR. TIN S WONG DO MEDICAL 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
1261QH0100XHealth Service Clinic/Center20A13729CA

General Provider Information

NPI Number : 1811449598
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. TIN S WONG DO MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 711 W COLLEGE ST STE 208
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-1093
Country : US
Telephone Number : 213-625-3182
Fax Number :
Provider Business Practice Location Address
First Line : 711 W COLLEGE ST STE 208
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-1093
Country : US
Telephone Number : 213-625-3182
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : TIN WONG
Credential : DO
Telephone Number : 213-625-3182
Provider Enumeration Date : 10/28/2016
Last Update Date : 12/09/2016

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