Provider Demographics
NPI:1780703983
Name:YEP H. WONG, M.D. INC
Entity type:Organization
Organization Name:YEP H. WONG, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEP
Authorized Official - Middle Name:H
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-680-9300
Mailing Address - Street 1:323 N PRAIRIE AVE # 334
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-680-9300
Mailing Address - Fax:310-672-1347
Practice Address - Street 1:323 N PRAIRIE AVE # 334
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-680-9300
Practice Address - Fax:310-672-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA14748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A19892Medicare UPIN
W4541Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CA00A14748AMedicare ID - Type UnspecifiedMEDI-CAL