Provider Demographics
NPI:1629789110
Name:DONG, WINGKIN
Entity Type:Individual
Prefix:MR
First Name:WINGKIN
Middle Name:
Last Name:DONG
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 1:19766 COLIMA ROAD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3265
Mailing Address - Country:US
Mailing Address - Phone:909-598-9885
Mailing Address - Fax:909-598-8755
Practice Address - Street 1:19766 COLIMA ROAD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3265
Practice Address - Country:US
Practice Address - Phone:909-598-9885
Practice Address - Fax:909-598-8755
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY44120Medicaid