Provider Demographics
NPI:1962622076
Name:WONG, YUNG PO
Entity type:Individual
Prefix:MR
First Name:YUNG
Middle Name:PO
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4828
Mailing Address - Country:US
Mailing Address - Phone:626-445-0373
Mailing Address - Fax:626-445-0373
Practice Address - Street 1:709 N HILL ST
Practice Address - Street 2:SUITE 23
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2361
Practice Address - Country:US
Practice Address - Phone:213-617-0088
Practice Address - Fax:213-617-2988
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist