Provider Demographics
NPI:1801087036
Name:WONG, KAREN YOUNG (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:YOUNG
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:GANIN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:23769 SUNSET CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1351
Mailing Address - Country:US
Mailing Address - Phone:909-895-7088
Mailing Address - Fax:
Practice Address - Street 1:1015 NOGALES ST STE 109
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1309
Practice Address - Country:US
Practice Address - Phone:626-965-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist