Provider Demographics
NPI:1700813060
Name:EMILY CHU WONG
Entity Type:Organization
Organization Name:EMILY CHU WONG
Other - Org Name:PING ON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:213-617-3333
Mailing Address - Street 1:640 N BROADWAY
Mailing Address - Street 2:STE 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2815
Mailing Address - Country:US
Mailing Address - Phone:213-617-3333
Mailing Address - Fax:213-617-3318
Practice Address - Street 1:640 N BROADWAY
Practice Address - Street 2:STE 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2815
Practice Address - Country:US
Practice Address - Phone:213-617-3333
Practice Address - Fax:213-617-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY228923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002913OtherPK
CAPHA228920Medicaid
CAPHY22892OtherSTATE PHARMACY LICENSE #
=========OtherFEDERAL TAX ID NUMBER
CA1124270001Medicare NSC
CA0577203OtherNABP NUMBER