Provider Demographics
NPI:1629319306
Name:WONG, ALEXIS SHENG
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:SHENG
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 1/2 S MYRTLE AVE STE 910
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5189
Mailing Address - Country:US
Mailing Address - Phone:626-410-0949
Mailing Address - Fax:
Practice Address - Street 1:521 1/2 S MYRTLE AVE STE 910
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5189
Practice Address - Country:US
Practice Address - Phone:626-410-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAPSY33369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator