Provider Demographics
NPI:1740595313
Name:WONG, MELISSA SPRING (MD, MHDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SPRING
Last Name:WONG
Suffix:
Gender:F
Credentials:MD, MHDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W 3RD ST STE 160W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6103
Mailing Address - Country:US
Mailing Address - Phone:310-423-0895
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 1001
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4170
Practice Address - Country:US
Practice Address - Phone:310-423-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055093207V00000X
CAA121495207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology