Provider Demographics
NPI:1023190733
Name:WONG, MONICA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:A
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90030-0220
Mailing Address - Country:US
Mailing Address - Phone:562-803-0124
Mailing Address - Fax:562-803-5569
Practice Address - Street 1:750 S PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-3129
Practice Address - Country:US
Practice Address - Phone:909-868-0235
Practice Address - Fax:909-623-0571
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT940YMedicare PIN
CAWA63973AMedicare PIN
CAHW11998EMedicare PIN
CAH04210Medicare UPIN