Provider Demographics
NPI:1386956407
Name:WONG, CARRIE KA LEI (DDS)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:KA LEI
Last Name:WONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:KA LEI
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3500 LOMITA BOULEVARD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5021
Mailing Address - Country:US
Mailing Address - Phone:310-530-7011
Mailing Address - Fax:310-530-1334
Practice Address - Street 1:3500 LOMITA BOULEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-530-7011
Practice Address - Fax:310-530-1334
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606671223G0001X, 1223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health