Provider Demographics
NPI:1720490790
Name:WONG, HEI-WAH (MD)
Entity Type:Individual
Prefix:
First Name:HEI-WAH
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:323 N PRAIRIE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4504
Mailing Address - Country:US
Mailing Address - Phone:310-392-8636
Mailing Address - Fax:310-392-6642
Practice Address - Street 1:323 N PRAIRIE AVE STE 210
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4504
Practice Address - Country:US
Practice Address - Phone:310-392-8636
Practice Address - Fax:310-392-6642
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA153630207Q00000X
WA60662864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine