MEDICARE: DR. ALBERT WONG M.D.

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	207T00000X	Neurological Surgery Physician	125052495	IL
2	207T00000X	Neurological Surgery Physician	DR.0065158	CO
3	207T00000X	Neurological Surgery Physician	A128308	CA

General Provider Information

NPI Number	:	1841429586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT WONG M.D.

Provider Business Mailing Address
First Line	:	444 S SAN VICENTE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4174
Country	:	US
Telephone Number	:	310-423-9780
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 S SAN VICENTE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4174
Country	:	US
Telephone Number	:	310-423-9780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	09/01/2022

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