Provider Demographics
NPI:1942378039
Name:WONG, LAI JING (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LAI
Middle Name:JING
Last Name:WONG
Suffix:
Gender:F
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 1:4867 SUNSET BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-9700
Mailing Address - Fax:323-783-4920
Practice Address - Street 1:4867 SUNSET BOULEVARD
Practice Address - Street 2:INPATIENT PHARMACY GROUND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-783-8308
Practice Address - Fax:323-783-4920
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH31422183500000X
NV06960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist