Provider Demographics
NPI:1609941053
Name:WONG, CARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:3831 HUGHES AVENUE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-837-3668
Mailing Address - Fax:888-382-5301
Practice Address - Street 1:3831 HUGHES AVENUE
Practice Address - Street 2:SUITE 700
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-837-3668
Practice Address - Fax:888-382-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE-3240213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine