Provider Demographics
NPI:1073725768
Name:HANSON P WONG M D
Entity Type:Organization
Organization Name:HANSON P WONG M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANSON
Authorized Official - Middle Name:PAO-SANG
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-804-7223
Mailing Address - Street 1:10230 ARTESIA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6768
Mailing Address - Country:US
Mailing Address - Phone:562-804-7223
Mailing Address - Fax:562-804-0165
Practice Address - Street 1:10230 ARTESIA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6768
Practice Address - Country:US
Practice Address - Phone:562-804-7223
Practice Address - Fax:562-804-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63718207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13907OtherMEDICARE PROVIDER NUMBER
CAE99996Medicare UPIN