Provider Demographics
NPI:1750412714
Name:ALLEN KING WONG, DDS, INC.
Entity type:Organization
Organization Name:ALLEN KING WONG, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DDS
Authorized Official - Phone:626-966-3131
Mailing Address - Street 1:320 W BADILLO ST STE 201
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1833
Mailing Address - Country:US
Mailing Address - Phone:626-966-3131
Mailing Address - Fax:626-966-7603
Practice Address - Street 1:320 W BADILLO ST STE 201
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1833
Practice Address - Country:US
Practice Address - Phone:626-966-3131
Practice Address - Fax:626-966-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420211223X0400X
CA149051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty