Provider Demographics
NPI:1821167875
Name:WONG, DAVID YEN MAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:YEN MAN
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3220 SEPULVEDA BLVD
Mailing Address - Street 2:103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2744
Mailing Address - Country:US
Mailing Address - Phone:310-326-8625
Mailing Address - Fax:310-326-1735
Practice Address - Street 1:3220 SEPULVEDA BLVD
Practice Address - Street 2:103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2744
Practice Address - Country:US
Practice Address - Phone:310-326-8625
Practice Address - Fax:310-326-1735
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-05-21
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Provider Licenses
StateLicense IDTaxonomies
CAG27287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43301Medicare UPIN