Provider Demographics
NPI:1194037481
Name:WONG, ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N HILL ST STE 18
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2352
Mailing Address - Country:US
Mailing Address - Phone:213-687-0888
Mailing Address - Fax:
Practice Address - Street 1:709 N HILL ST STE 18
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2352
Practice Address - Country:US
Practice Address - Phone:213-687-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily