Provider Demographics
NPI:1194901074
Name:SUZIE M. WONG DDS, INC
Entity type:Organization
Organization Name:SUZIE M. WONG DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-532-2774
Mailing Address - Street 1:18527 S WESTERN AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3830
Mailing Address - Country:US
Mailing Address - Phone:310-532-2774
Mailing Address - Fax:
Practice Address - Street 1:18527 S WESTERN AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3830
Practice Address - Country:US
Practice Address - Phone:310-532-2774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty