Provider Demographics
NPI:1508045428
Name:HING C. WONG
Entity Type:Organization
Organization Name:HING C. WONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-628-7958
Mailing Address - Street 1:709 N HILL ST STE 19
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:213-628-7958
Mailing Address - Fax:213-617-9731
Practice Address - Street 1:709 N HILL ST STE 19
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:213-628-7958
Practice Address - Fax:213-617-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA308100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W8657AMedicare PIN