Provider Demographics
NPI:1083983845
Name:WONG, ANDREW KING-WAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KING-WAH
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 N SEPULVEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2492
Mailing Address - Country:US
Mailing Address - Phone:310-802-8016
Mailing Address - Fax:310-802-8031
Practice Address - Street 1:3113 N SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2492
Practice Address - Country:US
Practice Address - Phone:310-802-8016
Practice Address - Fax:310-802-8031
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119262207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine