Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G87370 | CA |
NPI | 1417979626 |
---|---|
Provider Name | Kenneth H Wong |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 03/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G08817 | (02) |