Provider Demographics
NPI:1730483702
Name:WONG, DAVID JON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JON
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8969 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4934
Mailing Address - Country:US
Mailing Address - Phone:310-273-5126
Mailing Address - Fax:310-273-2265
Practice Address - Street 1:8969 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4934
Practice Address - Country:US
Practice Address - Phone:310-273-5126
Practice Address - Fax:310-273-2265
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist