Provider Demographics
NPI:1689727281
Name:WONG, MAY M (OD)
Entity Type:Individual
Prefix:
First Name:MAY
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:221 S BARRINGTON AVE
Mailing Address - Street 2:#104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3355
Mailing Address - Country:US
Mailing Address - Phone:310-471-0073
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND MALL
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2148
Practice Address - Country:US
Practice Address - Phone:510-887-2800
Practice Address - Fax:510-887-2812
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88048Medicare UPIN