Provider Demographics
NPI:1134334527
Name:MORIMOTO, KENJI WONG (MD)
Entity type:Individual
Prefix:DR
First Name:KENJI
Middle Name:WONG
Last Name:MORIMOTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1220 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3941
Mailing Address - Country:US
Mailing Address - Phone:310-913-2910
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:UCLA HOPSITAL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-794-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2021-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA960252080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology