Provider Demographics
NPI:1477871838
Name:WONG, CHUNG YING (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:YING
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4525
Mailing Address - Country:US
Mailing Address - Phone:323-735-0774
Mailing Address - Fax:323-735-1803
Practice Address - Street 1:1815 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4525
Practice Address - Country:US
Practice Address - Phone:323-735-0774
Practice Address - Fax:323-735-1803
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 35074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist