Provider Demographics
NPI:1124119979
Name:TIT SANG LI MD & NGA WAN WONG MD INC
Entity type:Organization
Organization Name:TIT SANG LI MD & NGA WAN WONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NGA
Authorized Official - Middle Name:WAN
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-898-9635
Mailing Address - Street 1:6181 GLENEAGLES CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5561
Mailing Address - Country:US
Mailing Address - Phone:714-898-9635
Mailing Address - Fax:714-898-9637
Practice Address - Street 1:6552 BOLSA AVE
Practice Address - Street 2:SUITE N
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-898-9635
Practice Address - Fax:714-898-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26311207R00000X, 261QA0005X
208D00000X
CAA25684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002451Medicaid
CAGR0002450Medicaid
CAGR0002451Medicaid
CAI08474Medicare UPIN
CAE01583Medicare UPIN