Provider Demographics
NPI:1629731658
Name:WONG, MILTON HENRY (RN, ADN, BSN)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:HENRY
Last Name:WONG
Suffix:
Gender:M
Credentials:RN, ADN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17562 GERALDINE LN APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8964
Mailing Address - Country:US
Mailing Address - Phone:714-915-0434
Mailing Address - Fax:
Practice Address - Street 1:3700 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1498
Practice Address - Country:US
Practice Address - Phone:562-531-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA824018163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty