Provider Demographics
NPI:1093803793
Name:WONG, TERENCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:BLD 500 RM 0205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4958
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BLD 500 RM 0205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4958
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA382831835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology