Provider Demographics
NPI:1700979846
Name:WONG, KUAN POK (MD)
Entity Type:Individual
Prefix:
First Name:KUAN POK
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 AURORA LN
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1300
Mailing Address - Country:US
Mailing Address - Phone:562-943-0398
Mailing Address - Fax:562-902-9949
Practice Address - Street 1:10230 ARTESIA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6763
Practice Address - Country:US
Practice Address - Phone:562-866-1764
Practice Address - Fax:562-867-7123
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262550Medicaid
A87018Medicare UPIN
CAWA26255CMedicare ID - Type Unspecified