Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A119262 | CA |
N | 111NI0900X | Internist | A119262 | CA |
Y | 207RA0201X | Internist - Allergy & Immunology | A119262 | CA |
NPI | 1083983845 |
---|---|
Provider Name | Dr. Andrew King-Wah Wong |
First Address | Manhattan Beach, CA 90266-2492 |
Second Address | Manhattan Beach, CA 90266-2492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2011 |
Last Update Date | 30/01/2021 |