Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60667 | CA |
N | 1223D0001X | Dental Public Health | 60667 | CA |
N | 1223G0001X | General Practice | 60667 | CA |
N | 213EG0000X | General Practice | 60667 | CA |
NPI | 1386956407 |
---|---|
Provider Name | Dr. Carrie Ka Lei Wong |
First Address | Torrance, CA 90505-5021 |
Second Address | Torrance, CA 90505-5021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 02/02/2012 |