MEDICARE: DR. ANDREA WONG D. C.

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	111N00000X	Chiropractor	32844	CA

General Provider Information

NPI Number	:	1891110086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA WONG D. C.

Provider Business Mailing Address
First Line	:	670 MONTEREY PASS RD
Second Line	:	SUITE 100
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-2436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 MONTEREY PASS RD
Second Line	:	SUITE 100
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-2436
Country	:	US
Telephone Number	:	626-551-5155
Fax Number	:

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

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	02/24/2014

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