Provider Demographics
NPI:1962554683
Name:WONG, THOMAS CHI-FAI (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHI-FAI
Last Name:WONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21434 MEYLER ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1860
Mailing Address - Country:US
Mailing Address - Phone:310-658-6656
Mailing Address - Fax:
Practice Address - Street 1:2204 TORRANCE BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-0501
Practice Address - Country:US
Practice Address - Phone:310-773-9868
Practice Address - Fax:310-693-8819
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC30431OtherCHIROPRACTIC LICENSE